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Sample records for acute ischaemic stroke

  1. Osteoprotegerin concentrations and prognosis in acute ischaemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper Khédri; Ueland, T; Gullestad, L;

    2010-01-01

    .1365-2796.2009.02163.x.Aim. Concentrations of osteoprotegerin (OPG) have been associated with the presence of vascular and cardiovascular diseases, but the knowledge of this marker in the setting of ischaemic stroke is limited. Methods and results. In 244 patients with acute ischaemic stroke (age: 69......Abstract. Jensen JK, Ueland T, Atar D, Gullestad L, Mickley H, Aukrust P, Januzzi JL (Odense University Hospital, Denmark; Rikshospitalet, Oslo, Norway; Massachusetts General Hospital, USA). Osteoprotegerin concentrations and prognosis in acute ischaemic stroke. J Intern Med 2009; doi: 10.1111/j...... at presentation included haemoglobin (T = -2.82; P = 0.005), creatinine (T = 4.56; P age (T = 9.66; P

  2. Imaging the ischaemic penumbra after acute ischaemic stroke using PET and {sup 18}F-Fluoromisonidazole

    Energy Technology Data Exchange (ETDEWEB)

    Read, S.J.; Hirano, T.; Abbott, D.F.; Sachinidis, J.I.; Tochon-Danguy, H.J.; Chan, J.G.; Egan, F.; Scott, A.M.; Bladin, C.F.; McKay, W.J.; Donna, G.A. [Austin and Repatriation Medical Centre, Melbourne, VIC (Australia). Departments of Neurology, Nuclear Medicine and Centre for Positron Emission Tomogrpahy]|[University of Melbourne, Melbourne, VIC (Australia). Department of Medicine

    1998-06-01

    Full text: Using PET with {sup 15}O-labelled oxygen and water, the ischaemic penumbra is currently defined as peri-infarct areas demonstrating misery perfusion. We have used PET with the hypoxic tissue marker {sup l8}F-fluoromisonidazole ({sup 18}F-FMISO) to detect hypoxic but viable peri-infarct tissue in patients after acute ischaemic stroke. Fifteen patients with acute ischaemic strokes were studied using PET and {sup 18}F-FMISO. Studies were performed within 48 hours of stroke in 7 patients, at 6-11 days after stroke in 2 patients, and serially during both time epochs in 6 patients. We objectively assessed tracer uptake using a statistically-based image thresholding method. The mean activity in the contralateral (normal) hemisphere was calculated, and the whole image thresholded so that pixels with activity > 3 SD above the mean were identified. Positive studies were those with high activity pixels ipsilateral to the infarct. Hypoxic tissue was detected in peri-infarct regions in 9 of the 13 patients studied within 48 hours of stroke. These areas were generally distributed in the peripheries of the final infarct volume. None of the 8 patients studied 6-11 days after stroke exhibited increased {sup I8}F- FMISO activity. The 6 patients studied both early and late all exhibited areas of increased activity on the early but not the late study, consistent with resolution of the penumbra by this time. The distribution of the hypoxic tissue identified with this method supports the hypothesis that these tissues are likely to comprise the ischaemic penumbra.

  3. Early phase combined therapeutic management of acute ischaemic stroke.

    Science.gov (United States)

    Bassi, P; Lattuada, P; Tonietti, S

    2005-05-01

    An adequate treatment of ischaemic stroke in the early phase (28-48 h) is the most important factor for a better outcome. Thrombolysis with rTPA (within 3 h) and oral ASA 300 mg/days are the first therapeutic misures. Continuous monitoring of cardiological and haemodinamic parameters allows early detection of cardiac disturbances. Treatment of hypertension, low haematic oxigenation, hyperglicaemia, seizures and hypertermia is basic to improve outcome. Pharmacological therapy is only one of the components of effective multidisciplinary integrated management of ischaemic stroke; we remind also the precocity of rehabilitation procedures and an accurate psychological assessment. PMID:15883687

  4. Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke

    NARCIS (Netherlands)

    Uyttenboogaart, M; Koch, M W; Koopman, K; Vroomen, P C; Luijckx, G J; De Keyser, J

    2008-01-01

    BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission lipi

  5. The imaging of ischaemic stroke

    International Nuclear Information System (INIS)

    Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)

  6. Hyperintense acute reperfusion marker is associated with higher contrast agent dosage in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Ostwaldt, Ann-Christin; Schaefer, Tabea; Villringer, Kersten; Fiebach, Jochen B. [Charite Universitaetsmedizin Berlin, Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Berlin (Germany); Rozanski, Michal; Ebinger, Martin [Charite Universitaetsmedizin Berlin, Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Berlin (Germany); Charite Universitaetsmedizin, Department of Neurology, Berlin (Germany); Jungehuelsing, Gerhard J. [Stiftung des Buergerlichen Rechts, Juedisches Krankenhaus Berlin, Berlin (Germany)

    2015-11-15

    The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery (FLAIR) images is associated with blood-brain barrier (BBB) permeability changes. The aim of this study was to examine the influence of contrast agent dosage on HARM incidence in acute ischaemic stroke patients. We prospectively included 529 acute ischaemic stroke patients (204 females, median age 71 years). Patients underwent a first stroke-MRI within 24 hours from symptom onset and had a follow-up on day 2. The contrast agent Gadobutrol was administered to the patients for perfusion imaging or MR angiography. The total dosage was calculated as ml/kg body weight and ranged between 0.04 and 0.31 mmol/kg on the first examination. The incidence of HARM was evaluated on day 2 FLAIR images. HARM was detected in 97 patients (18.3 %). HARM incidence increased significantly with increasing dosages of Gadobutrol. Also, HARM positive patients were significantly older. HARM was not an independent predictor of worse clinical outcome, and we did not find an association with increase risk of haemorrhagic transformation. A higher dosage of Gadobutrol in acute stroke patients on initial MRI is associated with increased HARM incidence on follow-up. MRI studies on BBB should therefore standardize contrast agent dosages. (orig.)

  7. The third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Cantisani Teresa

    2008-06-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rt-PA is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours, it can detect a 3% benefit. Trial procedures Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24–48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent (Modified Rankin 0–2 at six months (assessed via a postal questionnaire mailed directly to the patient. Secondary outcomes include: events within 7 days (death, recurrent stroke, symptomatic intracranial haemorrhage, outcome at six months (death, functional status, EuroQol. Trial registration ISRCTN25765518

  8. Asymmetric oro-facial angioedema following alteplase for acute ischaemic stroke.

    Science.gov (United States)

    Wu, Teddy Y; Wei, Diana Y; Baker, Yvette; Sharkey, Brendan; Frith, Richard W

    2014-11-01

    We present a patient with asymmetric oro-facial angioedema following thrombolysis for acute ischaemic stroke with serial photographs of this phenomenon. We discuss the mechanism for the development of asymmetric oro-facial oedema following thrombolysis and suggest a management plan. PMID:24974191

  9. Thrombolytics in acute ischaemic stroke: a guide to patient selection and optimum use.

    Science.gov (United States)

    Adams, H P

    2000-02-01

    Intravenously administered alteplase (recombinant tissue plasminogen activator; rtPA) is the only medical treatment that has been approved for the management of acute ischaemic stroke. Although rtPA has demonstrated efficacy in improving outcomes of patients with a wide range of neurological impairments, it cannot be given with impunity. Thrombolytic therapy is associated with a considerable risk of intracranial bleeding that is likely to be catastrophic. Careful selection of patients to treat and intensive ancillary care are the keys for successful administration of rtPA. An algorithm for selection is based on the interval from the onset of stroke, history of recent medical illnesses or use of medications, findings of the medical and neurological examinations and the results of laboratory and brain imaging studies. Because rtPA must be given within 3 hours of onset of stroke, most patients cannot be treated. Thus, additional therapies are needed for treatment of patients with acute ischaemic stroke. PMID:18034518

  10. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

    NARCIS (Netherlands)

    M. Geurts (Marjolein); H.B. Van Der Worp (H. Bart); A.D. Horsch (Alexander D.); L.J. Kappelle (Jaap); G.J. Biessels (Geert Jan); B.K. Velthuis (Birgitta); C.B. Majoie (Charles); Y.B.W.E.M. Roos; L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); K.E. Droogh-De Greve; H.P. Bienfait; M.A. van Walderveen (M.); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (W.); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); J. Bot (Joseph); M.C. Visser (Marieke); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); T. van Seeters (Tom); A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels; L.J. Kappelle; J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2015-01-01

    textabstractBackground: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine

  11. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    International Nuclear Information System (INIS)

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  12. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  13. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

    NARCIS (Netherlands)

    Seeters, T. van; Biessels, G.J.; Schaaf, I.C. van der; Dankbaar, J.W.; Horsch, A.D.; Luitse, M.J.; Niesten, J.M.; Mali, W.P.Th.; Kappelle, L.J.; Graaf, Y. van der; Velthuis, B.K.; Dijk, E.J. van

    2014-01-01

    BACKGROUND: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We

  14. ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute ischaemic stroke.

    Science.gov (United States)

    Vanacker, Peter; Heldner, Mirjam R; Seiffge, David; Mueller, Hubertus; Eskandari, Ashraf; Traenka, Christopher; Ntaios, George; Mosimann, Pascal J; Sztajzel, Roman; Mendes Pereira, Vitor; Cras, Patrick; Engelter, Stefan; Lyrer, Philippe; Fischer, Urs; Lambrou, Dimitris; Arnold, Marcel; Michel, Patrik

    2015-05-01

    Intravenous thrombolysis (IVT) as treatment in acute ischaemic strokes may be insufficient to achieve recanalisation in certain patients. Predicting probability of non-recanalisation after IVT may have the potential to influence patient selection to more aggressive management strategies. We aimed at deriving and internally validating a predictive score for post-thrombolytic non-recanalisation, using clinical and radiological variables. In thrombolysis registries from four Swiss academic stroke centres (Lausanne, Bern, Basel and Geneva), patients were selected with large arterial occlusion on acute imaging and with repeated arterial assessment at 24 hours. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. Performance of integer-based predictive model was assessed by bootstrapping available data and cross validation (delete-d method). In 599 thrombolysed strokes, five variables were identified as independent predictors of absence of recanalisation: Acute glucose > 7 mmol/l (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), large Arterial occlusion (A) and decreased Level of consciousness (L). All variables were weighted 1, except for (L) which obtained 2 points based on β-coefficients on the logistic scale. ASTRAL-R scores 0, 3 and 6 corresponded to non-recanalisation probabilities of 18, 44 and 74 % respectively. Predictive ability showed AUC of 0.66 (95 %CI, 0.61-0.70) when using bootstrap and 0.66 (0.63-0.68) when using delete-d cross validation. In conclusion, the 5-item ASTRAL-R score moderately predicts non-recanalisation at 24 hours in thrombolysed ischaemic strokes. If its performance can be confirmed by external validation and its clinical usefulness can be proven, the score may influence patient selection for more aggressive revascularisation strategies in routine clinical practice. PMID:25589216

  15. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.;

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  16. Platelet degranulation and monocyte-platelet complex formation are increased in the acute and convalescent phases after ischaemic stroke or transient ischaemic attack.

    LENUS (Irish Health Repository)

    McCabe, Dominick J H

    2004-06-01

    Flow cytometric studies suggest that platelets are activated in ischaemic stroke or transient ischaemic attack (TIA). However, few studies have measured circulating leucocyte-platelet complexes in this patient population. Whole blood flow cytometry was used to quantify the expression of CD62P-, CD63-, and PAC1-binding, and the percentages of leucocyte-platelet complexes in acute (1-27 d, n = 79) and convalescent (79-725 d, n = 70) ischaemic cerebrovascular disease (CVD) patients compared with controls without CVD (n = 27). We performed a full blood count, and measured plasma levels of soluble P-selectin, soluble E-selectin, and von Willebrand factor antigen (VWF:Ag) as additional markers of platelet and\\/or endothelial cell activation. The median percentage CD62P expression and the median percentage monocyte-platelet complexes were higher in both acute and convalescent CVD patients than controls (P <\\/= 0.02). The mean white cell count and mean VWF:Ag levels were significantly elevated in the acute and convalescent phases after ischaemic stroke or TIA (P <\\/= 0.02). Otherwise, there was no significant increase in any other marker of platelet or endothelial activation in CVD patients. There was a positive correlation between the percentage expression of CD62P and the percentages of both neutrophil-platelet and monocyte-platelet complexes in the acute phase, and the percentages of all leucocyte-platelet complexes in the convalescent phase after ischaemic CVD. This study provides evidence for ongoing excessive platelet and\\/or endothelial activation in ischaemic CVD patients despite treatment with antithrombotic therapy.

  17. Clinical trials with neuroprotective drugs in acute ischaemic stroke: are we doing the right thing?

    OpenAIRE

    J. De Keyser; Luiten, PG; Sulter, G

    1999-01-01

    Ischaemic stroke is a leading cause of death and long-lasting disability. Several neuroprotective drugs have been developed that have the potential to limit ischaemic brain damage and improve outcome for patients. While promising results with these drugs have been achieved in animal stroke models, all Phase III trials conducted so far indicate that these drugs have failed to live up to their promise. Despite the limits of animal models, which cannot mimic the clinical situation, the disappoin...

  18. Intravenous thrombolysis in acute ischaemic stroke: from trial exclusion criteria to clinical contraindications. An international Delphi study

    NARCIS (Netherlands)

    M. Dirks (Maaike); L.W. Niessen (Louis Wilhelmus); C.L. Franke (Cees); R.J. van Oostenbrugge (Robert Jan); D.W.J. Dippel (Diederik); P.J. Koudstaal (Peter Jan)

    2007-01-01

    textabstractOBJECTIVE: Several studies indicate that only a small proportion of patients with acute ischaemic stroke are treated with intravenous thrombolysis. Indications and contraindications for this treatment are usually based on the inclusion and exclusion criteria of randomised clinical trials

  19. Factors influencing outcome in acute ischaemic stroke : outcome scales, the role of blood glucose and rtPA treatment

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten

    2008-01-01

    This thesis describes several aspects that influence outcome in acute ischaemic strok. In the first part, two frequently used outcome scales - the Barthel index and modified Rankin scale - are studied and for both scales, optimal endpoints for stroke trials are proposed. In the second part, the rela

  20. Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: Finding the best thresholds

    Energy Technology Data Exchange (ETDEWEB)

    Roldan-Valadez, E., E-mail: ernest.roldan@usa.net [Magnetic Resonance Unit, Medica Sur Hospital and Clinic Foundation, Mexico City (Mexico); Gonzalez-Gutierrez, O.; Martinez-Lopez, M. [Magnetic Resonance Unit, Medica Sur Hospital and Clinic Foundation, Mexico City (Mexico)

    2012-03-15

    Aim: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. Materials and methods: Fifty-five patients with symptomatic hyperacute (first 6 h) or acute (7-24 h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. Results: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385 Multiplication-Sign 10{sup -6} mm{sup 2}/s, MTT at 109.5%, TTP at 3.05 s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p < 0.001). Conclusions: Based on the present findings, hyperacute penumbra is reliably defined with a TTP >3 s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke.

  1. Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Reich, Arno; Gindullis, Mirco; Schulz, Joerg B. [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Frohnhofen, Katharina; Pjontek, Rastislav; Brockmann, Marc-Alexander; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-01-15

    This study aims to investigate the clinical significance of post-interventional cerebral hyperdensities (PCHD) after endovascular mechanical thrombectomy in acute ischaemic stroke. Data of 102 consecutive patients who received post-interventional CT scans within 4.5 h after mechanical thrombectomy were analysed retrospectively. Sixty-two of 102 patients (60.8 %) had PCHD on their post-interventional CT scans. The most common site of PCHD was the basal ganglia. PCHD were persisting in 13 of 62 patients (21.0 %), and transient in the remaining 49 patients (79.0 %) within 24 h. Four patients with PCHD and four patients without PCHD suffered from parenchymal haemorrhage. Neither ASA nor Clopidogrel, Tirofiban or rtPA were risk factors for PCHD. Final infarction size was congruent with or bigger than areas of PCHD in 93.3 % of cases in our series. PCHD was not a risk factor for parenchymal haemorrhage in our series. The occurrence of PCHD was strongly related to the prior presence of infarction. PCHD was also a strong predictor for final infarction size. (orig.)

  2. Current concepts on magnetic resonance imaging (MRI) perfusion-diffusion assessment in acute ischaemic stroke: a review & an update for the clinicians.

    Science.gov (United States)

    Roldan-Valadez, Ernesto; Lopez-Mejia, Mariana

    2014-12-01

    Recently, several medical societies published joint statements about imaging recommendations for acute stroke and transient ischaemic attack patients. In following with these published guidelines, we considered it appropriate to present a brief, practical and updated review of the most relevant concepts on the MRI assessment of acute stroke. Basic principles of the clinical interpretation of diffusion, perfusion, and MRI angiography (as part of a global MRI protocol) are discussed with accompanying images for each sequence. Brief comments on incidence and differential diagnosis are also included, together with limitations of the techniques and levels of evidence. The purpose of this article is to present knowledge that can be applied in day-to-day clinical practice in specialized stroke units or emergency rooms to attend patients with acute ischaemic stroke or transient ischaemic attack according to international standards. PMID:25758570

  3. Current concepts on magnetic resonance imaging (MRI perfusion-diffusion assessment in acute ischaemic stroke: a review & an update for the clinicians

    Directory of Open Access Journals (Sweden)

    Ernesto Roldan-Valadez

    2014-01-01

    Full Text Available Recently, several medical societies published joint statements about imaging recommendations for acute stroke and transient ischaemic attack patients. In following with these published guidelines, we considered it appropriate to present a brief, practical and updated review of the most relevant concepts on the MRI assessment of acute stroke. Basic principles of the clinical interpretation of diffusion, perfusion, and MRI angiography (as part of a global MRI protocol are discussed with accompanying images for each sequence. Brief comments on incidence and differential diagnosis are also included, together with limitations of the techniques and levels of evidence. The purpose of this article is to present knowledge that can be applied in day-to-day clinical practice in specialized stroke units or emergency rooms to attend patients with acute ischaemic stroke or transient ischaemic attack according to international standards.

  4. Update on the third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited

    Directory of Open Access Journals (Sweden)

    Sandercock Peter

    2011-11-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rtPA is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics. Results The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2% of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials. Conclusion The data from the trial will: improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and

  5. Locally induced hypothermia for treatment of acute ischaemic stroke: a physical feasibility study.

    Science.gov (United States)

    Slotboom, J; Kiefer, C; Brekenfeld, C; Ozdoba, C; Remonda, L; Nedeltchev, K; Arnold, M; Mattle, H; Schroth, G

    2004-11-01

    During the treatment of stroke by local intra-arterial thrombolysis (LIT) it is frequently possible to pass the blood clot with a micro-catheter, allowing perfusion of brain tissue distally to the occlusion. This possibility allows for new early treatments of ischaemic brain tissue, even before the blood clot has been removed. One potential new approach to preserve brain tissue at risk may be locally induced endovascular hypothermia. Physical parameters such as the required micro-catheter input pressure, output velocity and flow rates, and a heat exchange model, applicable in the case of a micro-catheter placed within a guiding catheter, are presented. Also, a simple cerebral temperature model is derived that models the temperature response of the brain to the perfusion with coolant fluids. Based on this model, an expression has been derived for the time needed to reach a certain cerebral target temperature. Experimental in vitro measurements are presented that confirm the usability of standard commercially available micro-catheters to induce local hypothermia of the brain. If applied in vivo, the model predicts a local cooling rate of ischaemic brain tissue of 300 g of approximately 1 degrees C in 1 min, which is up to a factor 30-times faster than the time-consuming systemic hypothermia via the skin. Systemic body temperature is only minimally affected by application of local hypothermia, thus avoiding many limitations and complications known in systemic hypothermia. PMID:15551092

  6. Locally induced hypothermia for treatment of acute ischaemic stroke: A physical feasibility study

    International Nuclear Information System (INIS)

    During the treatment of stroke by local intra-arterial thrombolysis (LIT) it is frequently possible to pass the blood clot with a micro-catheter, allowing perfusion of brain tissue distally to the occlusion. This possibility allows for new early treatments of ischaemic brain tissue, even before the blood clot has been removed. One potential new approach to preserve brain tissue at risk may be locally induced endovascular hypothermia. Physical parameters such as the required micro-catheter input pressure, output velocity and flow rates, and a heat exchange model, applicable in the case of a micro-catheter placed within a guiding catheter, are presented. Also, a simple cerebral temperature model is derived that models the temperature response of the brain to the perfusion with coolant fluids. Based on this model, an expression has been derived for the time needed to reach a certain cerebral target temperature. Experimental in vitro measurements are presented that confirm the usability of standard commercially available micro-catheters to induce local hypothermia of the brain. If applied in vivo, the model predicts a local cooling rate of ischaemic brain tissue of 300 g of approximately 1 C in 1 min, which is up to a factor 30-times faster than the time-consuming systemic hypothermia via the skin. Systemic body temperature is only minimally affected by application of local hypothermia, thus avoiding many limitations and complications known in systemic hypothermia. (orig.)

  7. Predictors of early arrival at the emergency department in acute ischaemic stroke.

    LENUS (Irish Health Repository)

    Curran, C

    2012-01-31

    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

  8. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  9. A double-blind, placebo-controlled, randomized trial to evaluate the safety and efficacy of Cerebrolysin in patients with acute ischaemic stroke in Asia--CASTA.

    Science.gov (United States)

    Hong, Z; Moessler, H; Bornstein, N; Brainin, M; Heiss, W-D

    2009-10-01

    Cerebrolysin has exhibited neuroprotective as well as neurotrophic properties in various animal models of cerebral ischaemia and has shown clinical efficacy and good safety in several small controlled clinical studies in ischaemic stroke. Therefore, a large double-blind placebo-controlled randomized clinical trial was launched in Asia to prove the validity of this treatment strategy. In the more than 50 participating centres patients with acute ischemic hemispheric stroke are randomized within 12 hours of symptoms onset to treatment (30 ml Cerebrolysin diluted in physiologic saline) or placebo (saline) given as intravenous infusion once daily added to standard care for 10 days. The patients are followed with regular visits for 90 days. Efficacy is evaluated on day 90 by three outcome scales - modified Rankin Scale, Barthel Index and NIH Stroke Scale - combined to single global directional test. Additionally, adverse events are documented to prove safety. In this study a total of 1060 patients will be included and analysis of data will be completed in 2010. If positive, this trial will add an effective strategy to the treatment of acute ischaemic stroke.

  10. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Tijssen, M.P.M.; Stadler, A.A.R.; Zwam, W. van; Graaf, R. de; Postma, A.A. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Hofman, P.A.M. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, MhENS School for Mental Health and Neuroscience, Maastricht (Netherlands); Oostenbrugge, R.J. van [Maastricht University Medical Centre, Department of Neurology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, CARIM School for Cardiovascular Diseases, P.O. Box 616, Maastricht (Netherlands); Klotz, E. [Siemens Healthcare Sector, Computed Tomography, Forchheim (Germany); Wildberger, J.E. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, CARIM School for Cardiovascular Diseases, P.O. Box 616, Maastricht (Netherlands)

    2014-04-15

    To assess the feasibility of dual energy computed tomography (DE-CT) in intra-arterially treated acute ischaemic stroke patients to discriminate between contrast extravasation and intracerebral haemorrhage. Thirty consecutive acute ischaemic stroke patients following intra-arterial treatment were examined with DE-CT. Simultaneous imaging at 80 kV and 140 kV was employed with calculation of mixed images. Virtual unenhanced non-contrast (VNC) images and iodine overlay maps (IOM) were calculated using a dedicated brain haemorrhage algorithm. Mixed images alone, as ''conventional CT'', and DE-CT interpretations were evaluated and compared with follow-up CT. Eight patients were excluded owing to a lack of follow-up or loss of data. Mixed images showed intracerebral hyperdense areas in 19/22 patients. Both haemorrhage and residual contrast material were present in 1/22. IOM suggested contrast extravasation in 18/22 patients; in 16/18 patients this was confirmed at follow-up. The positive predictive value (PPV) of mixed imaging alone was 25 %, with a negative predictive value (NPV) of 91 % and accuracy of 63 %. The PPV for detection of haemorrhage with DE-CT was 100 %, with an NPV of 89 % and accuracy improved to 89 %. Dual energy computed tomography improves accuracy and diagnostic confidence in early differentiation between intracranial haemorrhage and contrast medium extravasation in acute stroke patients following intra-arterial revascularisation. (orig.)

  11. The neuroprotective role of erythropoietin in the management of acute ischaemic stroke: from bench to bedside.

    Science.gov (United States)

    Ntaios, G; Savopoulos, C; Chatzinikolaou, A; Hatzitolios, A I

    2008-12-01

    Recombinant human erythropoietin was produced soon after the discovery of the erythropoietin gene in 1985 and since then, it is used in various clinical conditions such as chronic renal failure. Moreover, experimental studies have shown that erythropoietin exerts neuroprotective action as well. Recently, a clinical trial yielded promising results concerning the use of erythropoietin in stroke management. In this review, we summarize the main data which suggest that recombinant human erythropoietin and its analogues may indeed have a role in stroke treatment. PMID:18513348

  12. Acute ischaemic stroke secondary to a mobile thrombus in the common carotid artery - case report

    Directory of Open Access Journals (Sweden)

    Bajkó Zoltán

    2015-04-01

    Full Text Available A mobile thrombus in the carotid arteries is a very rare ultrasonographic finding and is usually diagnosed after a neurological emergency, such as a transient ischemic attack or cerebral infarction. We present the case of a 54-year-old man with vascular risk factors (a heavy smoker, untreated hypertension who was admitted to the emergency unit with right sided hemiparesis and aphasia. A cerebral CT scan showed a left middle cerebral artery territory infarction. The duplex ultrasound examination revealed mild atherosclerotic changes in the right common and internal carotid arteries, right-sided complete subclavian steal phenomenon and a complicated hypoechoic atherosclerotic plaque in the left common carotid artery with a large mobile thrombus. Due to the high embolization risk, the patient was hospitalised and prescribed Aspirin together with low molecular weight Heparin. We recorded an improvement in the patient’s neurological status and the control duplex scan revealed disappearance of the thrombus. The presence of floating thrombus in a patient with clinical and imagistic evidence of stroke is a major therapheutic challenge for the neurologist. The treatment strategies are not standardized and must be individualized, however in our case parenteral anticoagulation proved to be successful.

  13. The Relationship Between Baseline Blood Pressure and Computed Tomography Findings in Acute Stroke Data From the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

    DEFF Research Database (Denmark)

    Sare, G.M.; Bath, P.M.W.; Gray, L.J.;

    2009-01-01

    Background and Purpose-High blood pressure (BP) is present in approximate to 80% of patients with acute ischemic stroke and is independently associated with poor outcome. There are few data examining the relationship between admission BP and acute CT findings. Methods-TAIST was a randomized...... associated with baseline BP. Conclusion-Although high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP...

  14. An exploration of the association between very early rehabilitation and outcome for the patients with acute ischaemic stroke in Japan: a nationwide retrospective cohort survey

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2010-07-01

    Full Text Available Abstract Background Very early rehabilitation is expected to improve functional outcomes after stroke, although its effectiveness has not been fully evaluated. The purpose of this study was to investigate the association between very early intervention (VEI, and patient outcomes at discharge by using nationwide large data and statistical treatment for selection bias. Methods In this study, we defined VEI as rehabilitation commencing within 3 days of stroke admission. The data were derived from a nationwide survey of acute-care hospitals conducted in 2007 for designing a reimbursement scheme and from a concurrent survey on rehabilitation services among a convenient subgroup of hospitals participating in the above survey. We included patients with a diagnosis code of ischaemic cerebrovascular disease with acute onset who underwent any rehabilitation services during hospitalisation. Surgery cases, those with no functional deficit, and those with a severe consciousness deficit upon admission were excluded. A total of 5,482 patients were enrolled from 294 hospitals. To correct for any potential selection bias, we used Friday admission as an instrumental variable (IV and conducted a bivariate probit model analysis. Results We found that VEI for acute stroke patients was significantly associated with a lesser degree of disability at discharge. Even after considering endogenous problems due to treatment selection, VEI improved the chance of reducing disability by 15.3% (p Conclusions These data suggest that VEI may lead to a better outcome with no increase in adverse events compared to delayed rehabilitation.

  15. Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging

    Energy Technology Data Exchange (ETDEWEB)

    Abels, Benjamin [University Hospital Erlangen, Institute of Radiology, Erlangen (Germany); University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg (Germany); Villablanca, J.P. [UCLA Medical Center, Department of Neuroradiology, Los Angeles, CA (United States); Tomandl, Bernd F. [Klinikum Bremen-Mitte, Department of Neuroradiology, Bremen (Germany); Uder, Michael; Lell, Michael M. [University Hospital Erlangen, Institute of Radiology, Erlangen (Germany)

    2012-12-15

    To compare ischaemic lesions predicted by different CT perfusion (CTP) post-processing techniques and validate CTP lesions compared with final lesion size in stroke patients. Fifty patients underwent CT, CTP and CT angiography. Quantitative values and colour maps were calculated using least mean square deconvolution (LMSD), maximum slope (MS) and conventional singular value decomposition deconvolution (SVDD) algorithms. Quantitative results, core/penumbra lesion sizes and Alberta Stroke Programme Early CT Score (ASPECTS) were compared among the algorithms; lesion sizes and ASPECTS were compared with final lesions on follow-up MRI + MRA or CT + CTA as a reference standard, accounting for recanalisation status. Differences in quantitative values and lesion sizes were statistically significant, but therapeutic decisions based on ASPECTS and core/penumbra ratios would have been the same in all cases. CTP lesion sizes were highly predictive of final infarct size: Coefficients of determination (R {sup 2}) for CTP versus follow-up lesion sizes in the recanalisation group were 0.87, 0.82 and 0.61 (P < 0.001) for LMSD, MS and SVDD, respectively, and 0.88, 0.87 and 0.76 (P < 0.001), respectively, in the non-recanalisation group. Lesions on CT perfusion are highly predictive of final infarct. Different CTP post-processing algorithms usually lead to the same clinical decision, but for assessing lesion size, LMSD and MS appear superior to SVDD. (orig.)

  16. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, Thomas; Christensen, A;

    2015-01-01

    BACKGROUND AND PURPOSE: The general awareness of atrial fibrillation is increasing. The key to prevent atrial fibrillation related stroke is oral anticoagulation therapy; however, it has often been proposed that oral anticoagulation therapy is under-utilized despite indication. The aim of the study...... was to examine the trends in atrial fibrillation rate in patients after acute ischaemic stroke and to determine whether the use of oral anticoagulation therapy increased from 2003 to 2011. METHODS: In the nationwide Danish Stroke Registry 55 551 patients (≥18 years) admitted with acute ischaemic...... stroke were identified. Frequency analysis and linear regression were used to assess trends in atrial fibrillation diagnosis and oral anticoagulation therapy prescription. RESULTS: A total of 17.1% (n = 9482) of ischaemic stroke patients had atrial fibrillation. The relative frequency of atrial...

  17. Ischaemic strokes : management in first six hours.

    Directory of Open Access Journals (Sweden)

    Dalal P

    2001-04-01

    Full Text Available Cerebrovascular disease (CVD or stroke is one of the foremost causes of high morbidity and mortality for many nations of the world, posing a major socio-economic challenge in the occupational and neuro-rehabilitational programmes of the ′stroke-survivors′. For example, in USA alone it has been estimated that a sum of 3261 million dollars is spent as direct cost for treatment, in addition to 4104 million dollars as indirect costs, consequent on economic losses of ′stroke victims′. Thus, the new concept in stroke pathophysiology and strategies for stroke prevention have assumed global importance. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15% of urban population is hypertensive (160/95 mm Hg or more. Though high blood pressure has the highest attributable risk for stroke, there are many other reasons such as patient′s compliance in taking medicine and poor followup in clinical practice that may lead to failure in reducing stroke mortality. In subjects, who have transient ischaemic attacks (TIAs, regular use of antiplatelet agents like aspirin is well established in prevention of stroke. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight. Associated conditions like diabetes mellitus etc. should also be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base stations for these surveys, because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

  18. Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke

    LENUS (Irish Health Repository)

    Merwick, A

    2011-05-01

    Background: Diffusion weighted imaging (DWI) signal abnormality after transient ischaemic attack (TIA) predicts early stroke, independently of other risk markers included in the ABCD3-I score. Early stroke recurrence detected on follow-up DWI after the acute-phase DWI may identify patients at high risk for subsequent clinicalstrokesstroke, cognitive impairment, and seizures. We aimed to determine the evolution of acute DWI lesions and rate of new ischaemic lesion (NIL) occurrence on follow-up DWI after TIA and minor stroke.\\r\

  19. The Impact of Cortical Lesions on Thalamo-Cortical Network Dynamics after Acute Ischaemic Stroke: A Combined Experimental and Theoretical Study.

    Science.gov (United States)

    van Wijngaarden, Joeri B G; Zucca, Riccardo; Finnigan, Simon; Verschure, Paul F M J

    2016-08-01

    The neocortex and thalamus provide a core substrate for perception, cognition, and action, and are interconnected through different direct and indirect pathways that maintain specific dynamics associated with functional states including wakefulness and sleep. It has been shown that a lack of excitation, or enhanced subcortical inhibition, can disrupt this system and drive thalamic nuclei into an attractor state of low-frequency bursting and further entrainment of thalamo-cortical circuits, also called thalamo-cortical dysrhythmia (TCD). The question remains however whether similar TCD-like phenomena can arise with a cortical origin. For instance, in stroke, a cortical lesion could disrupt thalamo-cortical interactions through an attenuation of the excitatory drive onto the thalamus, creating an imbalance between excitation and inhibition that can lead to a state of TCD. Here we tested this hypothesis by comparing the resting-state EEG recordings of acute ischaemic stroke patients (N = 21) with those of healthy, age-matched control-subjects (N = 17). We observed that these patients displayed the hallmarks of TCD: a characteristic downward shift of dominant α-peaks in the EEG power spectra, together with increased power over the lower frequencies (δ and θ-range). Contrary to general observations in TCD, the patients also displayed a broad reduction in β-band activity. In order to explain the genesis of this stroke-induced TCD, we developed a biologically constrained model of a general thalamo-cortical module, allowing us to identify the specific cellular and network mechanisms involved. Our model showed that a lesion in the cortical component leads to sustained cell membrane hyperpolarization in the corresponding thalamic relay neurons, that in turn leads to the de-inactivation of voltage-gated T-type Ca2+-channels, switching neurons from tonic spiking to a pathological bursting regime. This thalamic bursting synchronises activity on a population level through

  20. Reperfusión en el ictus isquémico agudo: estado actual y futuro Reperfusion in acute ischaemic stroke: present and future

    Directory of Open Access Journals (Sweden)

    M. Herrera

    2008-01-01

    the ischaemic cascade and prevention of recurrence are the therapeutic aims in the acute phase of ischaemic stroke. Thrombolytic treatment pursues the lysis of the dot occluding the intracranial artery. At present, the only approved thrombolytic treatment is the intravenous Recombinant Tissue Plasminogen Activator (rtPA. Its safety and efficacy within the first three hours of evolution of the ischaemic stroke have been demonstrated. Establishment of this treatment involves a profound change in the health structures and the training of the personnel responsible. The small therapeutic window and the limitations of this medicine in daily practice have led to the urgent exploration of new strategies: we review the reconsideration of exclusion criteria (especially in the elderly and in minor neurological deficits or those of rapid improvement, the widening of the therapeutic window beyond 3 hours with the selection of patients by multimodal image, the possibility of thrombolysis combined with antithrombotic drugs or with enhancement through ultrasound. We also review the new thrombolytics that are appearing and the intra-arterial thrombolysis approach and therapies of endovascular mechanical reperfusion.

  1. SERUM CREATINE KINASE MB IN ISCHAEMIC STROKE: A CASE CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Preethi

    2016-06-01

    Full Text Available AIM To estimate CK-MB levels in ischaemic stroke patients and know its correlation in stroke patients. OBJECTIVES Serum creatine kinase-MB, other cardiac enzymes (CK, SGOT, uric acid, lipid profile, fasting blood glucose, and blood pressure was recorded. CT scan and ECG were also considered for the study. The aim of study was to determine serum creatine kinase-MB and the vascular risk factors for ischaemic stroke in a series of patients with an ischaemic stroke and to compare them with a series of controls of same age. METHODS Fifty (50 consecutive patients with ischaemic stroke were compared with thirty (30 healthy controls of same age. Vascular risk factors were recorded and serum creatine kinase-MB was determined in all of them. RESULTS There was modest rise of CK-MB in initial stages of stroke as compared with controls. The increase in CK-MB among cases is highly significant with a P value of <0.001. CONCLUSION The modest rise in serum CK-MB, which have recorded in the initial stages of stroke suggest that acute myocardial involvement is a common complication than is generally recognized. It is more likely that acute myocardial dysfunction is a consequence rather than a cause of acute cerebrovascular lesion.

  2. Evaluation of migraine in patients with ischaemic stroke.

    Science.gov (United States)

    Taheri, M; Valipour, E; Rasuli, S; Sayad, A; Movafagh, A; Mahdi Eftekharian, M; Mazdeh, M

    2015-12-01

    An association between migraine and ischaemic stroke has been observed for many years, but the exact mechanisms by which migraine can lead to stroke are still unknown. The purpose of this study was to determine the prevalence of migraine headaches in patients with ischaemic stroke. In this prospective cohort study, we assessed 323 patients with ischaemic stroke; these diagnoses were assigned based on the International Headache Society criteria for migraine with or without aura. Patients were recruited without major risk factors such as stroke, hypertension, hyperlipidaemia, diabetes, taking oral contraceptive pills, history of drug abuse and trauma in issue of their Stroke. Data were collected via a written questionnaire upon admission and were analysed with SPSS version 16 software. Comparisons were performed using Mann-Whitney's U test and chi-square and t-test. Migraine headache was present in 11.2% (36 of 323) of patients, 8.1% of women and 3.1% of men. Migraine prevalence was highest in the age over 60  years. There was a history of migraine without aura for over 2  years in 6.2% of patients with ischaemic stroke. Also, we found no significant correlation between migraine headache and location of the lesion in patients with ischaemic stroke.

  3. Mechanical thrombectomy for ischaemic stroke: the first UK case series.

    Directory of Open Access Journals (Sweden)

    Nasar Ahmad

    Full Text Available BACKGROUND AND PURPOSE: Endovascular treatments have the potential to accelerate reperfusion in acute ischaemic stroke with large vessel occlusion. In the UK only a few stroke centres offer this interventional option. The University Hospital of North Staffordshire (UHNS has treated the largest number of cases in the UK. Results of the first 106 endovascular treatments (EVT are presented here. METHODS: All patients treated with EVT (intra-arterial thrombolysis (IAT, mechanical thrombectomy (MT or both, or an attempt at intervention for acute stroke at UHNS, Stoke-on-Trent, UK, were entered into a prospective register. Baseline demographic and clinical data, the National Institutes for Health Stroke Scale (NIHSS, imaging results including Thrombolysis in Cerebral Infarction (TICI score, and complications were recorded. Mortality, and modified Rankin score (mRS were assessed at 90 days. RESULTS: From December 2009 to January 2013 106 patients (mean age 64 years, median baseline NIHSS 18 were treated with EVT (thrombectomy ± IAT 83%, IAT alone 13%, neither 4%. Seventy-eight per cent of occlusions were in the anterior circulation. Intravenous bridging thrombolysis was performed in 81%. Revascularization was successful (TICI 2b/3 in 84%. The median time from stroke onset to the end of the procedure was 6 h 03 min. A good outcome (mRS ≤ 2 at 90 days was achieved in 48% with a mortality of 15%. Fatal or nonfatal symptomatic intracranial haemorrhage (sICH within 10 days occurred in 9%. The median length of stay was 14 days (31% discharged home ≤ 7 days. CONCLUSIONS: EVT led to good clinical outcomes in almost 50% of patients with severe strokes.

  4. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    2012-01-01

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was investiga

  5. Advances in the Management of Transient Ischaemic Attack and Stroke

    Directory of Open Access Journals (Sweden)

    Mayra J Montalvo

    2016-07-01

    Full Text Available Among many important advances in the management of transient ischaemic attack (TIA and stroke are: the updated definition of TIA; risk stratification scores for TIA; the urgent diagnostic and treatment process for TIA; thrombectomy treatment for large vessel occlusive ischaemic stroke; cryptogenic stroke evaluation and treatment, including long-term monitoring for paroxysmal atrial fibrillation; and strategies to improve outcomes for patients including mirror therapy for neglect and timing of mobilisation after stroke. Future research will focus on: antiplatelet strategies after TIA; selecting patients for treatment with recanalisation therapies in an extended time window; uncovering the cause of strokes previously defined as cryptogenic; and better defining the optimal timing and dose of mobilisation after stroke.

  6. Ischaemic stroke in children secondary to post varicella angiopathy.

    LENUS (Irish Health Repository)

    Hayes, B

    2007-01-01

    Varicella in childhood is a self-limiting disease, which usually follows a benign course. However, complications, although rare, may have serious consequences. Ischaemic stroke secondary to post varicella angiopathy is a well-described complication and is estimated to account for up to a third of all strokes in infants. We present three previously healthy children who presented to our centre with ischaemic cerebrovascular infarction due to varicella angiopathy. All three children first presented within six weeks after onset of varicella infection and had MRI changes characteristic of ischaemic stroke secondary to post varicella angiopathy. While one child made an excellent recovery being left with only a minor deficit, the remaining two children were left with considerable morbidity severely affecting quality of life. The varicella vaccine has been proven to be well tolerated, safe and effective. We conclude that varicella vaccination should be considered for inclusion in the vaccination schedule to prevent serious complications which while rare may have devastating consequences.

  7. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study)

    DEFF Research Database (Denmark)

    O'Donnell, Martin J; Xavier, Denis; Liu, Lisheng;

    2010-01-01

    BACKGROUND: The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk...... factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction. METHODS: We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days...... an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90.3% (85.3-93.7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were...

  8. The evaluation of cerebral oxygenation by oximetry in patients with ischaemic stroke.

    Directory of Open Access Journals (Sweden)

    Demet G

    2000-04-01

    Full Text Available AIMS: To evaluate the clinical significance of estimation of the regional cerebral oxygen saturation (rSO2 in the patients with ischaemic stroke by the cerebral oximetry during acute, sub-acute and chronic phases. SUBJECTS AND METHODS: In this prospective study, 24 patients with ischaemic stroke in the middle cerebral artery territory were included. A detailed clinical examination and appropriate laboratory investigations were carried out. The rSO2 was determined by oximetery (INVOS 3100-SD bilaterally on the first, third, seventh, and fifteenth days. The blood pressure, the peripheral capillary oxygen saturation and the arterial blood gas values were noted too. the changes were evaluated along with Glasgow coma scale (GCS using unpaired student t-test and one way ANOVA test. RESULTS: There were significant differences between the rSO2 values in acute, subacute and chronic phases on the side of the lesion (p value < 0.05. The values of oxygen saturation gradually increased throughout the chronic phase. These values showed a positive correlation with GCS, but the results were not significant statistically. The rSO2 values were also significantly higher on the non-lesional side than those on the lesion side in the acute phase (p= 0.0034, the discrepancy disappeared during the sub-acute and chronic phases. CONCLUSION: Cerebral oximetry can be used as a measure to evaluate the cerebral oxygenation during the various phases of ischaemic stroke. It has a potential to serve as a useful marker for detection of cerebral oxygenation imbalances, to judge the effectiveness of the management and for the follow-up of patients with ischaemic stroke.

  9. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    Directory of Open Access Journals (Sweden)

    Nambakam Tanuja

    2015-07-01

    Full Text Available BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. AIMS AND O BJECTIVES: 1. To estimate the prevalence of carotid artery stenosis in ischaemic stroke/transient ishaemic attack patients. 2. To estimate whether there was any association between carotid artery stenosis and important risk factors such as diabetes mellitus, hypertension, hyper lipid emia with control group. METHODS AND MATERIALS : Acute ischaemic / TIA stroke patients with CT - Brain showing infarcts were enrolled for the study. All patients were subjected to CT scan brain study and colour Doppler study of extracranial carotid arteries. The systolic and diastolic velocity of blood flow, and the ratio of peak systolic velocities of common carotid arteries were assessed. RESULTS : DM, HTN, Smoking & Hyperlipidemia acted as risk factors for carotid stenosis. The prevalence of carotid stenosi s in our study was 60%. The prevalence of mild, moderate and severe stenosis were 34%, 10% and 16% respectively. The distribution of carotid stenosis was equal on both sides. The statistical significance was calculated using Chi - square test. Statistical si gnificance was taken when P value was <0.05. Statistical analysis was carried using standard formulae. Microsoft Excel 2007 and SPSS (Statistical Package for Social Sciences Version 17.0 software were used for data entry and analysis. CONCLUSIONS : Caroti d stenosis was one of the common causes of ischaemic stroke. There was a statistically significant correlation between increasing age, male gender, smoking, d iabetes mellitus, hypertension

  10. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara; Garosi, Laurent; Skerritt, Geoff;

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospita...

  11. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H;

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  12. Acute myeloid leukaemia as a cause of acute ischaemic heart disease

    NARCIS (Netherlands)

    van Haelst, P.L.; Schot, Bart; Hoendermis, E.S.; van den Berg, M.P.

    2006-01-01

    Ischaemic heart disease is almost invariably the result of atherosclerotic degeneration of the coronary arteries. However, other causes of ischaemic heart disease should always be considered. Here we describe two patients with a classic presentation of ischaemic heart disease resulting from acute le

  13. Ischaemic stroke with intact atrial septum--exclude arteriovenous malformations.

    Science.gov (United States)

    Doering, Friederike; Eicken, Andreas; Hess, John

    2014-02-01

    A 44-year-old woman was referred to our centre for interventional cardiac catheterisation. The diagnostic work-up after a preceding ischaemic stroke led to the assumption of a patent foramen ovale due to a positive bubble study. Before the planned percutaneous closure of the patent foramen ovale, we performed a second bubble study, which showed an intact atrial septum. However, after two to three heart cycles bubbles could be detected in the left atrium, assuming a right-to-left shunt of an extracardiac origin most likely in the lung. We therefore performed cardiac catheterisation, yielding a pulmonary arteriovenous malformation in the lower lobe of the right lung. This was successfully closed interventionally by placing a Cook coil, as well as several plugs into the malformation and feeding vessels. PMID:23347820

  14. Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

    NARCIS (Netherlands)

    T.C.D. Rettig; B.J. Bouma; R.B.A. van den Brink

    2009-01-01

    Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years. Methods and results. We evaluated all patients aged 50 and under who were referred to

  15. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia;

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy...

  16. Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

    The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database.

  17. Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack

    DEFF Research Database (Denmark)

    Rathenborg, Lisbet Knudsen; Jensen, L P; Baekgaard, N;

    2013-01-01

    Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed after...

  18. From preoperative evaluation to stroke center: Management of postoperative acute ischemic stroke.

    Science.gov (United States)

    Boyer, Thomas; Sigaut, Stéphanie; Puybasset, Louis; Deltour, Sandrine; Clarençon, Frédéric; Degos, Vincent

    2016-08-01

    Perioperative acute ischaemic stroke is a rare complication with potentially catastrophic outcomes. It has been shown that paying attention to perioperative neurological deficits and acute ischaemic stroke prevention proves to be beneficial in avoiding these catastrophic outcomes and may lead to determining early therapeutic interventions. This article reviews the perioperative management (covering diagnosis and treatment), prevention (covering surgery postponement, management with anticoagulant/antiplatelet and the growing interest in statins and beta-blockers) and intraoperative recommendations (covering anaesthetic techniques, ventilation strategies, transfusion and blood pressure management) specifically for the general surgical population. A summary of current treatments is enlightened by recently described evidence for the effectiveness of mechanical thrombectomy. PMID:27091105

  19. In vivo bioimpedance measurement of healthy and ischaemic rat brain: implications for stroke imaging using electrical impedance tomography.

    OpenAIRE

    Dowrick, T.; Blochet, C.; Holder, D

    2015-01-01

    In order to facilitate the imaging of haemorrhagic and ischaemic stroke using frequency difference electrical impedance tomography (EIT), impedance measurements of normal and ischaemic brain, and clotted blood during haemorrhage, were gathered using a four-terminal technique in an in vivo animal model, a first for ischaemic measurements. Differences of 5-10% in impedance were seen between the frequency spectrums of healthy and ischaemic brain, over the frequency range 0-3 kHz, while the spect...

  20. Acute ischaemic brain lesions in intracerebral haemorrhage: multicentre cross-sectional magnetic resonance imaging study.

    Science.gov (United States)

    Gregoire, Simone M; Charidimou, Andreas; Gadapa, Naveen; Dolan, Eamon; Antoun, Nagui; Peeters, Andre; Vandermeeren, Yves; Laloux, Patrice; Baron, Jean-Claude; Jäger, Hans R; Werring, David J

    2011-08-01

    Subclinical acute ischaemic lesions on brain magnetic resonance imaging have recently been described in spontaneous intracerebral haemorrhage, and may be important to understand pathophysiology and guide treatment. The underlying mechanisms are uncertain. We tested the hypothesis that ischaemic lesions are related to magnetic resonance imaging markers of the severity and type of small-vessel disease (hypertensive arteriopathy or cerebral amyloid angiopathy) in a multicentre, cross-sectional study. We studied consecutive patients with intracerebral haemorrhage from four specialist stroke centres, and age-matched stroke service referrals without intracerebral haemorrhage. Acute ischaemic lesions were assessed on magnetic resonance imaging (imaging. White matter changes and cerebral microbleeds were rated with validated scales. We investigated associations between diffusion-weighted imaging lesions, clinical and radiological characteristics. We included 114 patients with intracerebral haemorrhage (39 with clinically probable cerebral amyloid angiopathy) and 47 age-matched controls. The prevalence of diffusion-weighted imaging lesions was 9/39 (23%) in probable cerebral amyloid angiopathy-related intracerebral haemorrhage versus 6/75 (8%) in the remaining patients with intracerebral haemorrhage (P = 0.024); no diffusion-weighted imaging lesions were found in controls. Diffusion-weighted imaging lesions were mainly cortical and were associated with mean white matter change score (odds ratio 1.14 per unit increase, 95% confidence interval 1.02-1.28, P = 0.024) and the presence of strictly lobar cerebral microbleeds (odds ratio 3.85, 95% confidence interval 1.15-12.93, P = 0.029). Acute, subclinical ischaemic brain lesions are frequent but previously underestimated after intracerebral haemorrhage, and are three times more common in cerebral amyloid angiopathy-related intracerebral haemorrhage than in other intracerebral haemorrhage types. Ischaemic brain lesions are

  1. The role of atrial fibrillation on mortality and morbidity in patients with ischaemic stroke

    International Nuclear Information System (INIS)

    Objective: To investigate the impact of atrial fibrillation on mortality and morbidity in ischaemic stroke patients. Methods: The retrospective study was conducted at the Neurology Clinic, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey, and comprised records of ischaemic stroke patients hospitalised between January 2006 and September 2009. SPSS 13 was used for statistical analysis. Results: Of the 404 patients in the study, 69 (17.1%) had atrial fibrilation. The mean age of such patients was 66.78+9-12.23 years compared to 61.01+-15.11 years for the rest. Besides 47 (68.1%) of these patients were females. According to the modified Rankin Scale scores, the degree of disability was significantly higher at the time of arrival and discharge, and mortality rates were significantly higher also (p<0.01). Conclusion: Atrial fibrillation affected the prognosis of ischaemic stroke adversely in terms of mortality and morbidity. (author)

  2. The role of atrial fibrillation on mortality and morbidity in patients with ischaemic stroke

    International Nuclear Information System (INIS)

    To investigate the impact of atrial fibrillation on mortality and morbidity in ischaemic stroke patients. Methods: The retrospective study was conducted at the Neurology Clinic, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey, and comprised records of ischaemic stroke patients hospitalised between January 2006 and September 2009. SPSS 13 was used for statistical analysis. Results: Of the 404 patients in the study, 69 (17.1%) had atrial fibrilation. The mean age of such patients was 66.78+-12.23 years compared to 61.01+-15.11 years for the rest. Besides 47 (68.1%) of these patients were females. According to the modified Rankin Scale scores, the degree of disability was significantly higher at the time of arrival and discharge, and mortality rates were significantly higher also (p<0.01). Conclusion: Atrial fibrillation affected the prognosis of ischaemic stroke adversely in terms of mortality and morbidity. (author)

  3. Ischaemic strokes in patients with pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia: associations with iron deficiency and platelets.

    Directory of Open Access Journals (Sweden)

    Claire L Shovlin

    Full Text Available BACKGROUND: Pulmonary first pass filtration of particles marginally exceeding ∼7 µm (the size of a red blood cell is used routinely in diagnostics, and allows cellular aggregates forming or entering the circulation in the preceding cardiac cycle to lodge safely in pulmonary capillaries/arterioles. Pulmonary arteriovenous malformations compromise capillary bed filtration, and are commonly associated with ischaemic stroke. Cohorts with CT-scan evident malformations associated with the highest contrast echocardiographic shunt grades are known to be at higher stroke risk. Our goal was to identify within this broad grouping, which patients were at higher risk of stroke. METHODOLOGY: 497 consecutive patients with CT-proven pulmonary arteriovenous malformations due to hereditary haemorrhagic telangiectasia were studied. Relationships with radiologically-confirmed clinical ischaemic stroke were examined using logistic regression, receiver operating characteristic analyses, and platelet studies. PRINCIPAL FINDINGS: Sixty-one individuals (12.3% had acute, non-iatrogenic ischaemic clinical strokes at a median age of 52 (IQR 41-63 years. In crude and age-adjusted logistic regression, stroke risk was associated not with venous thromboemboli or conventional neurovascular risk factors, but with low serum iron (adjusted odds ratio 0.96 [95% confidence intervals 0.92, 1.00], and more weakly with low oxygen saturations reflecting a larger right-to-left shunt (adjusted OR 0.96 [0.92, 1.01]. For the same pulmonary arteriovenous malformations, the stroke risk would approximately double with serum iron 6 µmol/L compared to mid-normal range (7-27 µmol/L. Platelet studies confirmed overlooked data that iron deficiency is associated with exuberant platelet aggregation to serotonin (5HT, correcting following iron treatment. By MANOVA, adjusting for participant and 5HT, iron or ferritin explained 14% of the variance in log-transformed aggregation-rate (p = 0

  4. Comparing perfusion CT evaluation algorithms for predicting outcome after endovascular treatment in anterior circulation ischaemic stroke

    International Nuclear Information System (INIS)

    Aim: To analyse perfusion CT (PCT) evaluation algorithms for their predictive value for outcome after endovascular therapy (ET) in acute ischaemic stroke. Materials and methods: Twenty-six patients were prospectively enrolled to undergo endovascular therapy for moderate to severe [National Institute of Health Stroke Scale (NIHSS) score of ≥5] anterior circulation stroke ≤6 h of onset. PCT datasets were evaluated according to three algorithms: visual mismatch estimate (VME), Alberta Stroke Programme Early CT Score (ASPECTS) perfusion, and quantitative perfusion ratios (QPRs: RCBF, RCBV) of cerebral blood flow (CBF) and volume (CBV). Results were correlated with outcome measures [NIHSS score at discharge, NIHSS score change until discharge (ΔNIHSSA/D), mRS at 90 days (mRS90d)] and compared with a matched control group. Results: Recanalization was achieved in 73%, median NIHSS score decreased from 14 to 5 at discharge. The treatment and control group did not differ by VME and ASPECTS perfusion, nor did VME correlate with any of the three outcome measures. ASPECTS perfusion was not predictive of any outcome measure in the ET group. RCBF and RCBV were associated with ΔNIHSSA/D in controls and, inversely, the ET group, but not with mRS90d. Receiver operating characteristic (ROC) analysis of RCBF (and RCBV) showed a positive predictive and negative predictive value of 87% (78%) and 74% (73%), respectively, for discriminating major neurological improvement (ΔNIHSSA/D <7 versus ≥7). Conclusions: Implementation of QPRs for CBF and CBV are superior to clinically used VME and ASPECTS perfusion evaluation methods for predicting early outcome after ET for anterior circulation stroke. - Highlights: • Quantitative Perfusion ratios (qPR) can be derived from Perfusion CT data sets. • qPR have a high predictive value for discriminating major neurological improvement. • qPR are superior compared to ASPECTS perfusion for predicting early outcome

  5. Neuroprotection as initial therapy in acute stroke - Third report of an Ad Hoc Consensus Group Meeting

    NARCIS (Netherlands)

    Bogousslavsky, J; De Keyser, J; Diener, HC; Fieschi, C; Hacke, W; Kaste, M; Orgogozo, JM; Pulsinelli, W; Wahlgren, NG

    1998-01-01

    Although a considerable body of scientific data is now available on neuroprotection in acute ischaemic stroke, this field is not yet established in clinical practice. At its third meeting, the European Ad Hoc Consensus Group considered the potential for neuroprotection in acute stroke and the practi

  6. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    2008-01-01

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (

  7. Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke.

    Science.gov (United States)

    Guo, Yutao; Wang, Hao; Tian, Yingchun; Wang, Yutang; Lip, Gregory Y H

    2016-01-01

    Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8% male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1%) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95%CI 0.34-0.35) in the non-AF population and 1.11 (0.84-1.45) with AF. The AF population age risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such 'high risk' patients.

  8. Ischaemic Markers in Acute Hepatic Injury

    Science.gov (United States)

    Jena, Sushanta Kumar; Nanda, Rachita; Mangaraj, Manaswini; Nayak, Parsuram

    2016-01-01

    Introduction Hepatic injury of varied aetiology may progress to Acute Liver Failure (ALF). Compromised microcirculation is thought to be a deciding factor of hepatic hypoxia may be involved in disease progression that needs early detection. Ischaemia markers like serum Ischaemia- modified albumin (IMA), ALT-LDH ratio and ALT-LDH index have been suggested for its detection at early stage. Aim To find out the association of Ischaemia markers like serum IMA, ALT-LDH ratio and ALT-LDH index in acute hepatic injury cases. Materials and Methods Forty one diagnosed acute liver injury cases of varied aetiology admitted in Department of Medicine, and Gastroenterology of SCB Medical College, Cuttack were enrolled in the study along with 30 age and sex matched healthy controls. Blood collected at time of admission and at time of discharge (1st day and 7th day) were evaluated for FPG, RFT, LFT, Serum Albumin along with serum LDH, IMA, PT-INR and platelet count. Result Serum bilirubin, hepatic enzymes, IMA, PT-INR was more markedly raised in cases than controls on the 1st day of admission. ALT-LDH ratio and index were significantly low in complicated cases. However, on responding to treatment the ALT-LDH index on 7th day registered a rise in comparison to the 1st day, while serum IMA revealed an insignificant decline showing improvement in hepatic hypoxia. ALT-LDH ratio remains more or less same on response to treatment. Conclusion Serum IMA and ALT-LDH Index reveals association with disease process in Acute Hepatic Injury cases both clinically and biochemically and can be used as supportive parameters for the diagnosis of disease process. PMID:27190791

  9. Genetic risk factors for ischaemic stroke and its subtypes (the METASTROKE collaboration)

    DEFF Research Database (Denmark)

    Traylor, Matthew; Farrall, Martin; Holliday, Elizabeth G;

    2012-01-01

    Various genome-wide association studies (GWAS) have been done in ischaemic stroke, identifying a few loci associated with the disease, but sample sizes have been 3500 cases or less. We established the METASTROKE collaboration with the aim of validating associations from previous GWAS and identify...

  10. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  11. Bronchogenic adenocarcinoma presenting as a synchronous solitary lytic skull lesion with ischaemic stroke--case report and literature review.

    LENUS (Irish Health Repository)

    O'Connell, David

    2011-01-01

    The authors describe a rare case of metastatic bronchogenic adenocarcinoma in a 55-year-old man presenting with concomittant solitary lytic skull lesion and ischaemic stroke. Metastatic bronchogenic carcinoma is known to present as lytic skull lesions. Primary brain tumours are also known to cause ischaemic brain injury. An underlying stroke risk may be exagerated by cranial tumour surgery. Patients with brain tumours are well known to be predisposed to an increased risk of developing thromboembolic disease. It is unusual to see metastatic bronchogenic adenocarcinoma presenting as ischaemic stroke with a background of concomittant cerebral metastasis. The aetio-pathogenesis of this rare occurrence is discussed with a review of literature.

  12. ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial

    DEFF Research Database (Denmark)

    Boysen, Gudrun; Krarup, Lars-Henrik; Zeng, Xianrong;

    2009-01-01

    OBJECTIVES: To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity. DESIGN: Multicentre, multinational, randomised clinical trial with masked outcome assessment. SETTING: Stroke units in Denmark, China...... infarction, or falls and fractures. CONCLUSION: Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score. More intensive strategies seem to be needed to promote physical activity after ischaemic stroke...

  13. Commentary on a GWAS: HDAC9 and the risk for ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Hacke Werner

    2012-07-01

    Full Text Available Abstract Modifiable risk factors like obesity, hypertension, smoking, physical inactivity or atrial fibrillation account for a significant proportion of the risk for ischaemic stroke, but genetic variation is also believed to contribute to the risk, although few genetic risk variants were identified to date. Common clinical subtypes of stroke are caused by cardiac embolism, large artery atherosclerosis and small cerebral vessel disease. Each of these underlying pathologies may have a specific genetic architecture. Previous genome-wide association studies (GWAS showed association of variants near PITX2 and ZFHX3 with atrial fibrillation and stroke. ANRIL (antisense Non-coding RNA in the INK4 Locus (harboring the CDKN2A/B genes variants were related to a variety of vascular diseases (myocardial infarction, aortic and intracranial aneurysm, including ischaemic stroke. Now a recent GWAS published in Nature Genetics confirmed these previous associations, analyzed the specificity of the previous associations with particular stroke subtypes and identified a new association between HDAC9 and large vessel stroke. The findings suggest that well-recognized clinical stroke subtypes correspond to distinct aetiological entities. However, the molecular pathways that are affected by the identified genetic variants are not yet pinpointed, and the observed associations apply only for some, but not all victims of a specific stroke aetiology.

  14. [Ingestion of anabolic steroids and ischaemic stroke. A clinical case report and review of the literature].

    Science.gov (United States)

    García-Esperón, Carlos; Hervás-García, José Vicente; Jiménez-González, Marta; Pérez de la Ossa-Herrero, Natalia; Gomis-Cortina, Meritxell; Dorado-Bouix, Laura; López-Cancio Martinez, Elena; Castaño-Duque, Carlos H; Millán-Torné, Mónica; Dávalos, Antonio

    2013-03-16

    INTRODUCTION. Anabolic-androgenic steroids are synthetic substances derived from testosterone that are employed for their trophic effect on muscle tissue, among other uses. Their consumption can give trigger a series of adverse side effects on the body, including the suppression of the hypothalamus-pituitary-gonadal axis as well as liver, psychiatric and cardiovascular disorders. The most common effects are altered fat profiles and blood pressure values, cardiac remodelling, arrhythmias or myocardial infarcts. CASE REPORT. We report the case of a young male, with a background of anabolic-androgenic steroids abuse, who visited because of an acute neurological focus in the right hemisphere related with an ischaemic stroke. The aetiological study, including cardiac monitoring, echocardiograph and imaging studies (magnetic resonance and arteriography) and lab findings (thrombophilia, serology, autoimmunity, tumour markers) showed no alterations. CONCLUSIONS. The association between consumption of anabolic-androgenic steroids and cardiovascular pathologies is known, but its relation with cerebrovascular disease has not received so much attention from researchers. PMID:23483467

  15. Functional recovery differs between ischaemic and haemorrhagic stroke patients

    NARCIS (Netherlands)

    Schepers, Vera P. M.; Ketelaar, Marjoliin; Visser-Meily, Anne J. M.; de Groot, Vincent; Twisk, Jos W. R.; Lindeman, Eline

    2008-01-01

    Objective: To determine whether there is a difference between patients with a cerebral infarction and those with an intracerebral haemorrhage with respect to the development of independence in activities of daily living over the first year post-stroke. Methods: Patients after first-ever stroke who w

  16. 提高急性缺血性卒中静脉溶栓有效性和安全性的研究进展%Study Progress of Improvement of Safety and Efifcacy of Intravenous Thrombolysis on Acute Ischaemic Stroke

    Institute of Scientific and Technical Information of China (English)

    吴岩峰; 刘庆萍; 丁红

    2016-01-01

    The recombinant tissue plasminogen activator alteplase (rt-PA) is the most effective therapeutic drug used in intravenous thrombolysis for patients with acute ischaemic stroke presenting within 4.5h after symptom onset. Nevertheless, intravenous thrombolysis is accompanied with hemorrhagic transformation (HT), increased risk of symptomatic intracranial haemorrhage (sICH), poor prognosis and even deaths. Therefore, study on inlfuential factors on treatment and prognosis and improvement of efifcacy and safety of intravenous thrombolysis has important signiifcance for prognosis of patients with acute ischemic stroke.%重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator alteplase,rt-PA)是目前急性缺血性卒中时间窗内静脉溶栓最有效的治疗药物,然而,静脉溶栓也伴随着出血转化、症状性颅内出血风险的增加,导致患者预后不良,甚至死亡。因此,研究静脉溶栓治疗及预后的影响因素,提高静脉溶栓治疗的有效性及安全性,对急性缺血性卒中患者的预后有着重大意义。

  17. Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke

    DEFF Research Database (Denmark)

    Christensen, L M; Krieger, D W; Højberg, S;

    2014-01-01

    BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial...... patients (16.1%). In three patients PAF was detected by other methods before or after monitoring and was undiscovered due to device sensitivity in one case. The first event of PAF was documented at a mean of 109 days (SD ±48) after stroke onset. PAF was asymptomatic in all cases and occurred in episodes...... lasting predominantly between 1 and 4 h. Four recurrent strokes were observed, three in patients with PAF; all three patients were on oral anticoagulation (OAC). CONCLUSIONS: One in five patients with CS had PAF, which occurred at low burden and long after stroke. Future studies should determine the role...

  18. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Gislason, Gunnar H; Jørgensen, Casper H;

    2011-01-01

    AimsPsoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis.Methods and resultsCohort study of the entire Danish population...... followed from 1997 to 2006 by individual-level-linkage of nationwide prospectively recorded registers. Multivariable Poisson's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke. A total of 36 765 patients with mild psoriasis and 2793 with severe...... psoriasis were compared with 4 478 926 individuals, i.e. the reference population. In patients with mild psoriasis, the adjusted rate ratios (RRs) for AF were 1.50 (1.21-1.86) and 1.16 (1.08-1.24) in patients aged...

  19. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    is directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...

  20. Cerebrogenic tachyarrhythmia in acute stroke

    Directory of Open Access Journals (Sweden)

    A S Praveen Kumar

    2012-01-01

    Full Text Available The electrocardiac abnormalities following acute stroke are frequent and seen in both ischemic and hemorrhagic stroke. The changes seen in electrocardiogram (ECG consist of repolarization abnormalities such as ST elevation, ST depression, negative T waves, and QT prolongation. Among tachyarrhythmias, atrial fibrillation is the most common and occurrence of focal atrial tachycardia is very rare though any cardiac arrhythmias can follow acute stroke. We report a case of focal atrial tachycardia following acute ischemic stroke in 50-year-old female without structural heart disease, and their mechanisms and clinical implications.

  1. Cerebrogenic tachyarrhythmia in acute stroke

    OpenAIRE

    A S Praveen Kumar; Babu, E; D K Subrahmanyam

    2012-01-01

    The electrocardiac abnormalities following acute stroke are frequent and seen in both ischemic and hemorrhagic stroke. The changes seen in electrocardiogram (ECG) consist of repolarization abnormalities such as ST elevation, ST depression, negative T waves, and QT prolongation. Among tachyarrhythmias, atrial fibrillation is the most common and occurrence of focal atrial tachycardia is very rare though any cardiac arrhythmias can follow acute stroke. We report a case of focal atrial tachycardi...

  2. Impact of implementing evidence-based acute stroke interventions on survival: the South London Stroke Register.

    Directory of Open Access Journals (Sweden)

    Juliet Addo

    Full Text Available BACKGROUND: Studies examining the impact of organised acute stroke care interventions on survival in subgroups of stroke patients remain limited. AIMS: This study examined the effects of a range of evidence-based interventions of acute stroke care on one year survival post-stroke and determined the size of the effect across different socio-demographic and clinical subgroups of patients. METHODS: Data on 4026 patients with a first-ever stroke recruited to the population-based South London Stroke Register between 1995 and 2010 were used. In uni-variable analyses, one year cumulative survival rates in socio-demographic groups and by care received was determined. Survival functions were compared using Log-rank tests. Multivariable Cox models were used to test for interactions between components of care and age group, sex, ethnic group, social class, stroke subtype and level of consciousness. RESULTS: 1949 (56.4% patients were admitted to a stroke unit. Patients managed on a stroke unit, those with deficits receiving specific rehabilitation therapies and those with ischaemic stroke subtype receiving aspirin in the acute phase had better one year survival compared to those who did not receive these interventions. The greatest reduction in the hazards of death among patients treated on a stroke unit were in the youngest patients aged <65 years, (HR 0.39; 95% CI: 0.25-0.62, and those with reduced levels of consciousness, GCS <9, (HR: 0.44; CI: 0.33-0.58. CONCLUSIONS: There was evidence of better one year survival in patients receiving specific acute interventions after stroke with a significantly greater effect in stroke subgroups, suggesting the possibility of re-organising stroke services to ensure that the most appropriate care is made accessible to patients likely to derive the most benefits from such interventions.

  3. The risk factors and outcomes of gastrointestinal bleeding in acute ischaemic stroke%缺血性脑卒中并发消化道出血危险因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    邓晓风

    2012-01-01

    Objective Gastrointestinal(GI) bleeding is one of most serious complications after acute stage of ischemic stroke. This study is to investigate the risk factors as well as the prognosis of those cases with GI bleeding following acute stroke. Methods From Mar 2008 to Aug 2010, we prospectively collected ischemic stroke patients with or without GI bleeding in our intensive care unit grouped as research group and controls. A six month follow-up was conducted. Comparison was done between groups on the aspect of demography, predisposing factors and prognosis. Results Overall 3. 5% of GI bleeding was observed a-mong those ischemic stroke patients. The four major risk factors were coma ( 0R5.0 95% CI 1.4 ~ 17. 5 ) , incontinence ( OR5. 8 95% CI 1. 5 - 22. 2 ) , history of peptic ulcer or GI bleeding ( OR5. 2 95% CI 1. 3 ~ 21.1) and history of stroke ( OR3. 6 95% CI 1. 0 ~ 12. 7)respectively. During the follow-up, higher mortality rate was detected in research group (45. 5% ) especially those with sever GI bleeding (50% ) than that in controls (10% ). Conclusion Although GI bleeding is not a relative common complication after acute ischemic stroke, we should notice that it is associated with increased death risk. Thus we should be focused more attention on those risk factors.%目的 消化道出血是脑卒中后最严重的并发症之一.本研究探讨比较了其危险因素及相关预后.方法 收集2008年3月~2010年8月,我院重症监护室收治的脑梗死并发上消化道出血的患者(研究组)以及未并发上消化道出血的脑梗死患者(对照组),并进行6个月的随访.比较相关人口学数据、危险因素及相关预后.结果 研究发现,脑梗死并发消化道出血发生率为3.5%,其高危因素主要为昏迷(OR5.0 95% CI 1.4 ~ 17.5)、大小便失禁(OR5.8 95% CI1.5 ~22.2)、消化道溃疡或出血病史(OR5.2 95%CI 1.3 ~21.1)以及既往卒中病史(OR3.6 95%CI 1.0 ~ 12.7).在6个月的随访

  4. Clinical Evaluation of Aspirin and Sustained-release Dipyridamole in the Prevention and Treatment of Ischaemic Cerebrovascular Events After Acute Ischemic Stroke%阿司匹林联合缓释型双嘧达莫防治急性缺血性卒中后脑血管缺血事件的临床评价

    Institute of Scientific and Technical Information of China (English)

    冯慧玲; 杨冠涛

    2012-01-01

    目的 评价阿司匹林联合缓释型双嘧达莫防治急性缺血性卒中后脑血管缺血事件的临床作用.方法 选择2009年2月-2012年1月清苑县人民医院收治的63例急性缺血性卒中患者作为研究对象,根据抗血小板治疗药物使用情况分为A组33例和B组30例,A组采用阿司匹林联合缓释型双嘧达莫治疗,B组仅采用阿司匹林治疗,比较两组对脑血管缺血事件的防治作用.结果 A、B两组治疗后的神经功能缺损评分均明显改善,以A组改善更为明显(P<0.05);随访6个月,A组脑血管缺血事件发生率为3.0%,B组为23.3%,组间差异有统计学意义(P<0.05);两组均无严重不良反应发生.结论 阿司匹林联合缓释型双嘧达莫防治急性缺血性卒中后脑血管缺血事件的临床作用显著,能明显改善患者的神经功能,减少脑血管缺血事件的发生,并且安全性好,是临床首选的药物治疗方案之一.%Objective To evaluate the clinical effect of aspirin and sustained - release dipyridamole in the prevention and treatment of ischaemic cerebrovascular events after acute ischemic stroke. Methods From February 2009 to January 2012, 63 patients with acute ischemic stroke in the People's Hospital of Qingyuan County were selected as the research objects. According to the usage of antiplatelet therapy, they were divided into group A (n= 33) and group B (n= 30). The patients in group A were treated with aspirin plus sustained — release dipyridamole, while the patients in group B were only treated with aspirin. The prevention and treatment effects in the two groups were compared. Results After the treatment, the neurological deficit scores of groups A and B were both significantly improved, but the score in group A was improved more significantly (P< 0.05). Six- month follow — up outcome showed that the incidence rates of ischaemic cerebrovascular event in groups A and B were 3.0% and 23.3% respectively, and the difference

  5. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature...... is directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought...

  6. In vivo bioimpedance measurement of healthy and ischaemic rat brain: implications for stroke imaging using electrical impedance tomography.

    Science.gov (United States)

    Dowrick, T; Blochet, C; Holder, D

    2015-06-01

    In order to facilitate the imaging of haemorrhagic and ischaemic stroke using frequency difference electrical impedance tomography (EIT), impedance measurements of normal and ischaemic brain, and clotted blood during haemorrhage, were gathered using a four-terminal technique in an in vivo animal model, a first for ischaemic measurements. Differences of 5-10% in impedance were seen between the frequency spectrums of healthy and ischaemic brain, over the frequency range 0-3 kHz, while the spectrum of blood was predominately uniform. The implications of imaging blood/ischaemia in the brain using electrical impedance tomography are discussed, supporting the notion that it will be possible to differentiate stroke from haemorrhage. PMID:26006171

  7. In vivo bioimpedance changes during haemorrhagic and ischaemic stroke in rats: towards 3D stroke imaging using electrical impedance tomography.

    Science.gov (United States)

    Dowrick, T; Blochet, C; Holder, D

    2016-06-01

    Electrical impedance tomography (EIT) could be used as a portable non-invasive means to image the development of ischaemic stroke or haemorrhage. The purpose of this study was to examine if this was possible using time difference imaging, in the anesthetised rat using 40 spring-loaded scalp electrodes with applied constant currents of 50-150 μA at 2 kHz. Impedance changes in the largest 10% of electrode combinations were  -12.8%  ±  12.0% over the first 10 min for haemorrhage and  +46.1%  ±  37.2% over one hour for ischaemic stroke (mean  ±  SD, n  =  7 in each group). The volume of the pathologies, assessed by tissue section and histology post-mortem, was 12.6 μl  ±  17.6 μl and 12.6 μl  ±  17.6 μl for haemorrhage and ischaemia respectively. In time difference EIT images, there was a correspondence with the pathology in 3/7 cases of haemorrhage and none of the ischaemic strokes. Although the net impedance changes were physiologically reasonable and consistent with expectations from the literature, it was disappointing that it was not possible to obtain reliable EIT images. The reason for this are not clear, but probably include confounding effects of secondary ischaemia for haemorrhage and tissue and cerebrospinal fluid shifts for the stroke model. With this method, it does not appear that EIT with scalp electrodes is yet ready for clinical use. PMID:27200510

  8. [Pregnancy and acute ischemic stroke].

    Science.gov (United States)

    Bereczki, Dániel

    2016-05-15

    Pregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits.

  9. [Cerebrolysin for acute ischemic stroke].

    Science.gov (United States)

    iganshina, L E; Abakumova, T R

    2013-01-01

    The review discusses existing evidence of benefits and risks of cerebrolysin--a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue with proposed neuroprotective and neurotrophic properties, for acute ischemic stroke. The review presents results of systematic search and analysis of randomised clinical trials comparing cerebrolysin with placebo in patients with acute ischemic stroke. Only one trial was selected as meeting quality criteria. No difference in death and adverse events between cerebrolysin and placebo was established. The authors conclude about insufficiency of evidence to evaluate the effect of cerebrolysin on survival and dependency in people with acute ischemic stroke. PMID:23805635

  10. [Cerebrolysin for acute ischemic stroke].

    Science.gov (United States)

    iganshina, L E; Abakumova, T R

    2013-01-01

    The review discusses existing evidence of benefits and risks of cerebrolysin--a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue with proposed neuroprotective and neurotrophic properties, for acute ischemic stroke. The review presents results of systematic search and analysis of randomised clinical trials comparing cerebrolysin with placebo in patients with acute ischemic stroke. Only one trial was selected as meeting quality criteria. No difference in death and adverse events between cerebrolysin and placebo was established. The authors conclude about insufficiency of evidence to evaluate the effect of cerebrolysin on survival and dependency in people with acute ischemic stroke.

  11. Survival and clinical outcome of dogs with ischaemic stroke

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Toft, Nils; Westrup, Ulrik;

    2013-01-01

    survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered...... in terms of survival and clinical outcome. However, owners should be informed of the risk of acute death within 30days and of the possibility of new neurological events in survivors. Mortality was increased in dogs with right-sided lesions in this study....

  12. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik;

    2011-01-01

    GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were...

  13. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich;

    2013-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  14. Risk factors for perinatal arterial ischaemic stroke in full-term infants : a case-control study

    NARCIS (Netherlands)

    Harteman, Johanna C.; Groenendaal, Floris; Kwee, Anneke; Welsing, Paco M. J.; Benders, Manon J. N. L.; de Vries, Linda S.

    2012-01-01

    Objective The incidence of perinatal arterial ischaemic stroke (PAIS) is about 1 in 2300 live births. Evidence about the aetiology is still lacking. The aim of this study was to identify maternal, perinatal and neonatal risk factors for symptomatic PAIS in full-term infants. Methods Each full-term i

  15. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Blake Catherine

    2009-02-01

    Full Text Available Abstract Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing, modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity and diabetes mellitus. Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention. Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population. A Cochrane review highlighted as priority, the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease. Methods A single blind randomised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack (TIA and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure, lipid profile, smoking and diabetic status and lifestyle factors of habitual smoking, exercise and healthy eating participation. Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale, the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test. A total of 144 patients, over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA, will be recruited from Dublin community stroke services and two tertiary T.I.A clinics. Exclusion criteria will include oxygen dependence, unstable cardiac conditions, uncontrolled diabetes, major medical conditions, claudication, febrile illness, pregnancy or cognitive impairment. Participants will be block-statified, randomly allocated to one of two groups using a pre-prepared computer generated randomisation schedule. Both groups will receive a two hour education class on risk reduction post stroke. The

  16. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... of infarcts. For a number of years, tight glycemic control has been regarded as beneficial in critically illness, but recent research has been unable to support this notion. The only completed randomized study on glucose-lowering therapy in stroke has failed to demonstrate effect, and concerns relating...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  17. Auditory Hallucinations in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Yair Lampl

    2005-01-01

    Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

  18. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.)

  19. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  20. ACUTE STROKE: FUNCTIONAL OUTCOME PREDICTORS

    Directory of Open Access Journals (Sweden)

    Sujatha

    2016-03-01

    Full Text Available BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess functional outcome in these patients using Barthel Index at admission and at discharge. MATERIALS AND METHODS The present study was undertaken under the Department of Internal Medicine, Govt. Stanley Hospital, Chennai, in 75 patients above 18 yrs. of age presenting with symptoms suggestive of acute stroke at medical OPD/wards/ICU, proven by imaging as ischemic stroke after proper consent were subjected to detailed history taking, complete physical examination and the relevant laboratory investigations as per proforma. Subjects were grouped under mild/moderate/severe categories as per Barthel scoring. A prospective observational study design was chosen and descriptive statistics was done for all data and suitable statistical tests of comparison were done. RESULTS The groups contain subjects with the same basic demographic characteristics, age and gender. The duration of stay in hospital increases with Barthel score. There is an increasing trend of diabetes mellitus and hypertension with stroke severity assessed functionally as per Barthel scores. There is an increasing trend of raised CRP, ESR levels, Uric Acid and Fibrinogen levels with stroke severity. By assessing the functional outcome using Barthel index in ischemic stroke patients at admission and discharge, the average Barthel score in patients at the time of admission was 52.27 in comparison to significantly increased Barthel score at discharge (56 with a p-value of 0.0000 according to paired t-test. CONCLUSION CRP

  1. Neuroprotection in acute ischemic stroke

    NARCIS (Netherlands)

    De Keyser, Jacques; Uyttenboogaart, Maarten; Koch, Marcus W; Elting, Jan Willem; Sulter, Geert; Vroomen, Patrick C; Luijckx, Gert Jan

    2005-01-01

    Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with int

  2. Preclinical drug evaluation for combination therapy in acute stroke using systematic review, meta-analysis, and subsequent experimental testing

    OpenAIRE

    O'Collins, Victoria E; Macleod, Malcolm R.; Cox, Susan F; van Raay, Leena; Aleksoska, Elena; Donnan, Geoffrey A.; Howells, David W.

    2010-01-01

    There is some evidence that in animal models of acute ischaemic stroke, combinations of neuroprotective agents might be more efficacious than the same agents administered alone. Hence, we developed pragmatic, empirical criteria based on therapeutic target, cost, availability, efficacy, administration, and safety to select drugs for testing in combination in animal models of acute stroke. Magnesium sulphate, melatonin, and minocycline were chosen from a library of neuroprotective agents, and w...

  3. Three-dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract

    Energy Technology Data Exchange (ETDEWEB)

    Kunimatsu, A.; Aoki, S.; Masutani, Y.; Abe, O.; Mori, H.; Ohtomo, K. [Department of Radiology, Graduate School of Medicine, Tokyo University, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo (Japan)

    2003-08-01

    Diffusion tensor MR imaging (DTI) provides information on diffusion anisotropy, which can be expressed with three-dimensional (3D) white matter tractography. We used 3D white matter tractography to show the corticospinal tract in eight patients with acute or early subacute ischaemic stroke involving the posterior limb of the internal capsule or corona radiata and to assess involvement of the tract. Infarcts and the tract were shown simultaneously, providing information on their spatial relationships. In five of the eight patients, 3D fibre tract maps showed the corticospinal tract in close proximity to the infarct but not to pass through it. All these patients recovered well, with maximum improvement from the lowest score on manual muscle testing (MMT) up to the full score through rehabilitation. In the other three patients the corticospinal tract was shown running through the infarct; reduction in MMT did not necessarily improve favourably or last longer, other than in one patient. As 3D white matter tractography can show spatial relationships between the corticospinal tract and an infarct, it might be helpful in prognosis of gross motor function. (orig.)

  4. Three-dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract

    International Nuclear Information System (INIS)

    Diffusion tensor MR imaging (DTI) provides information on diffusion anisotropy, which can be expressed with three-dimensional (3D) white matter tractography. We used 3D white matter tractography to show the corticospinal tract in eight patients with acute or early subacute ischaemic stroke involving the posterior limb of the internal capsule or corona radiata and to assess involvement of the tract. Infarcts and the tract were shown simultaneously, providing information on their spatial relationships. In five of the eight patients, 3D fibre tract maps showed the corticospinal tract in close proximity to the infarct but not to pass through it. All these patients recovered well, with maximum improvement from the lowest score on manual muscle testing (MMT) up to the full score through rehabilitation. In the other three patients the corticospinal tract was shown running through the infarct; reduction in MMT did not necessarily improve favourably or last longer, other than in one patient. As 3D white matter tractography can show spatial relationships between the corticospinal tract and an infarct, it might be helpful in prognosis of gross motor function. (orig.)

  5. Three-dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract.

    Science.gov (United States)

    Kunimatsu, A; Aoki, S; Masutani, Y; Abe, O; Mori, H; Ohtomo, K

    2003-08-01

    Diffusion tensor MR imaging (DTI) provides information on diffusion anisotropy, which can be expressed with three-dimensional (3D) white matter tractography. We used 3D white matter tractography to show the corticospinal tract in eight patients with acute or early subacute ischaemic stroke involving the posterior limb of the internal capsule or corona radiata and to assess involvement of the tract. Infarcts and the tract were shown simultaneously, providing information on their spatial relationships. In five of the eight patients, 3D fibre tract maps showed the corticospinal tract in close proximity to the infarct but not to pass through it. All these patients recovered well, with maximum improvement from the lowest score on manual muscle testing (MMT) up to the full score through rehabilitation. In the other three patients the corticospinal tract was shown running through the infarct; reduction in MMT did not necessarily improve favourably or last longer, other than in one patient. As 3D white matter tractography can show spatial relationships between the corticospinal tract and an infarct, it might be helpful in prognosis of gross motor function. PMID:12856090

  6. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J;

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome. In...... addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  7. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS):a partial-factorial randomised controlled trial

    OpenAIRE

    Bath, Philip M. W.; Woodhouse, Lisa; Scutt, Polly; Krishnan, Kailash; Wardlaw, Joanna M; Bereczki, Daniel; Sprigg, Nikola; Berge, Eivind; Beridze, Maia; Caso, Valeria; Chen, Christopher; Christensen, Hanne; Collins, Ronan; El Etribi, Anwar; Laska, Ann Charlotte

    2015-01-01

    BACKGROUND: High blood pressure is associated with poor outcome after stroke. Whether blood pressure should be lowered early after stroke, and whether to continue or temporarily withdraw existing antihypertensive drugs, is not known. We assessed outcomes after stroke in patients given drugs to lower their blood pressure.METHODS: In our multicentre, partial-factorial trial, we randomly assigned patients admitted to hospital with an acute ischaemic or haemorrhagic stroke and raised systolic blo...

  8. Hyperhomocysteinaemia And Vitamin B12 Deficiency In Ischaemic Strokes In India

    Directory of Open Access Journals (Sweden)

    Wadia R S

    2004-01-01

    Full Text Available Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID. Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes and those on vitamin supplements were excluded. cases were divided into vegetarian (including those taking milk and / Or eggs, those who took non-vegetarian 4 or less times a month, and frequent non-vegetarians taking 5 or more times a month. Serum total homocysteine, serum B12 and folate levels were studied along with all other routine parameters. For comparison we examined 101 controls without HID, stroke, peripheral vascular disease, rental failure or recent vitamin intake. With the international norm for homocysteine given as 5-15 umol/litre (1we called serum homocysteine 16 umol/litre or more as raised. There were 147 cases of ischcmic stroke :119 arterial and 28 venous infarcts. In the arterial strokes 99 of 119 cases (83.19% had raised serum Homocysteine including 25 of 27 (92.5% of those with arterial stroke before age 45. Of 28 cases with venous infarct 21 (75% had raised homocysteine (HCY. Hyperhomocysteinemia was the commonest risk factor for stroke in our populations. Out of the total 147 cases the exact dietary intake was not known for ten cases., 58 were vegetarians, 54 were occasional non vegetarians (NV and 25 were frequent NV. In the 58 vegetarians, 55 had serum HCY> 16 umol/1 (94.8% and of those vegetarians with HCY> 16, serum B12 <200pg/ml was seen in 44 (75.8% and between 200-300 pg/ml in five (8.6%. Of the 54 occasional NV, 46 had HCY>16umo/1 (85.2% Of those with HCY >16, serum B12 level of <200 pg/ ml was seen in 28 (51.85% occ. NV and

  9. PISA. The effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute stroke: protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

    NARCIS (Netherlands)

    E.J. van Breda (Eric); H.B. van der Worp (Bart); H.M.A. van Gemert (Maarten); R. Meijer; L.J. Kappelle (Jaap); P.J. Koudstaal (Peter Jan); D.W.J. Dippel (Diederik)

    2002-01-01

    textabstractBACKGROUND: During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may

  10. PISA. The effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

    NARCIS (Netherlands)

    E.J. van Breda (Eric); B. van der Worp (Bart); M. van Gemert (Maarten); R.J. Meijer (Ron); L.J. Kappelle (Jaap); P.J. Koudstaal (Peter Jan); D.W.J. Dippel (Diederik)

    2002-01-01

    textabstractBackground: During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may improve their func

  11. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures.

    Directory of Open Access Journals (Sweden)

    Evonne Low

    Full Text Available Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS seizures.Retrospective observational study.Neonates >37 weeks born between 2003 and 2011 in two hospitals.Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1-2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%.Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

  12. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST)

    DEFF Research Database (Denmark)

    Sandset, Else Charlotte; Bath, Philip M W; Boysen, Gudrun;

    2011-01-01

    BACKGROUND: Raised blood pressure is common in acute stroke, and is associated with an increased risk of poor outcomes. We aimed to examine whether careful blood-pressure lowering treatment with the angiotensin-receptor blocker candesartan is beneficial in patients with acute stroke and raised...... blood pressure. METHODS: Participants in this randomised, placebo-controlled, double-blind trial were recruited from 146 centres in nine north European countries. Patients older than 18 years with acute stroke (ischaemic or haemorrhagic) and systolic blood pressure of 140 mm Hg or higher were included...... to treatment allocation. There were two co-primary effect variables: the composite endpoint of vascular death, myocardial infarction, or stroke during the first 6 months; and functional outcome at 6 months, as measured by the modified Rankin Scale. Analyses were by intention to treat. The study is registered...

  13. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Directory of Open Access Journals (Sweden)

    Hamed Asadi

    Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter

  14. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  15. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  16. Acute [corrected] stroke thrombolysis: an update [corrected].

    Science.gov (United States)

    Mehdiratta, Manu; Caplan, Louis R

    2007-01-01

    Acute stroke therapy took a major step forward in 1996 after the approval of Intravenous (IV) tissue plasminogen activator (t-PA) by the US Food and Drug Administration for patients presenting within 3 hours of the onset of stroke symptoms. Since that time, there have been considerable advances in imaging techniques as well as the advent of devices to help in the management of acute stroke patients. As a result, the arsenal to treat acute stroke has grown, and the field of stroke as a subspecialty of neurology has emerged. Despite these advances, only 3% to 8% of eligible patients with acute stroke in the United States are administered thrombolytics.(1) We herein review the use of thrombolytics in stroke and provide an overview of the imaging advances, new devices, and recent trials that are shaping modern stroke therapy. Finally, we provide a practical approach to the management of acute stroke, specifically for the practicing cardiologist, who may encounter stroke during cardiac catheterization, post myocardial infarction (MI), and in a variety of other settings. PMID:17498523

  17. REDUCTION DEGREE OF LOW-DENSITY LIPOPROTEINS CHOLESTEROL LEVELS ACCORDING TO DIFFERENT DOSES OF STATINS; ITS EFFECT ON THE RISK OF ISCHEMIC HEART DISEASE ACUTE EPISODES DEPENDING ON TREATMENT DURATION; AND RISK OF ISCHEMIC AND THROMBOEMBOLIC STROKE. COMMENT ON THE PAPER OF LAW M.R., WALD N.J., RUDNICKA A.R. QUANTIFYING EFFECT OF STATINS ON LOW DENSITY LIPOPROTEIN CHOLESTEROL, ISCHAEMIC HEART DISEASE, AND STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS. BMJ 2003; 326:1423-1427

    Directory of Open Access Journals (Sweden)

    N. V. Perova

    2016-01-01

    Full Text Available Comparative dose-dependent ability of different statins to lower serum low-density lipoproteins (LDL cholesterol was determined in three large meta-analysis. Besides, it was found that standardized decrease in LDL cholesterol levels on 1.0 or 1.8 mmol/l leads to rate reduction in ischemic heart disease acute episodes as well as stroke depending on treatment duration. Effect of LDL cholesterol reduction on stroke occurrence was more significant in studies, which included a major share of patients with vascular disease, because these patients have a higher risk of thromboembolic stroke (rather than haemorrhagic stroke in comparison with the general population.

  18. Prehospital care of the acute stroke patient.

    Science.gov (United States)

    Rajajee, Venkatakrishna; Saver, Jeffrey

    2005-06-01

    Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed. PMID:16194754

  19. ROLE OF COMPUTED TOMOGRAPHY PERFUSION IN EVALUATION OF EARLY ACUTE STROKE-A TWO YEARS STUDY IN RIMS, IMPHAL

    Directory of Open Access Journals (Sweden)

    Meenakumari

    2015-12-01

    Full Text Available OBJECTIVE Detection of acute strokes along with assessment of size of infarct core and penumbra with computed tomography perfusion (CTP imaging. METHOD Thirty patients with signs and symptoms of acute cerebrovascular accident underwent a plain CT scan (NCCT followed by CTP and a follow-up NCCT or Diffusion-weighted MRI (DWI within 7 days from symptom onset. RESULT Of the total 29 patients with acute ischaemic stroke confirmed by followup DWI, NCCT correctly detected 18 cases of acute ischaemic infarction (64.28%, whereas CTP could correctly detect 24 cases of acute ischaemic infarction (85.7%. Out of the 24 patients with abnormal perfusion CT studies found during the study period, there were total of 69 aspects areas of perfusion abnormalities with 48 areas of infarct core and 21 areas of perfusion mismatch. CONCLUSION CTP is much more sensitive than NCCT in detection of acute stroke and CTP can also detect penumbra area in shorter investigation time as compared to DWI, proving its usefulness in planning for thrombolysis.

  20. Impact of metabolic disorders on the relation between overweight/obesity and incident myocardial infarction and ischaemic stroke in fertile women

    DEFF Research Database (Denmark)

    Andersen, S S; Andersson, C; Berger, S M;

    2015-01-01

    and smoking, the risk of the composite outcome of myocardial infarction and ischaemic stroke was assessed with metabolic disorders (i.e. hypertensive conditions, abnormal glucose metabolism and/or dyslipidaemia) included as time-dependent variables. RESULTS: The population comprised 261,489 women with median...... be beneficial to reduce cardiovascular disease in overweight/obese young women....

  1. Clot lysis time and the risk of myocardial infarction and ischaemic stroke in young women; results from the RATIO case-control study

    NARCIS (Netherlands)

    Siegerink, Bob; Meltzer, Mirjam E.; de Groot, Philip G.; Algra, Ale; Lisman, Ton; Rosendaal, Frits R.

    2012-01-01

    Reduced overall fibrinolytic capacity increases the risk of myocardial infarction (MI), as demonstrated in studies with predominantly male participants. We determined the influence of altered fibrinolysis on the risk of MI and ischaemic stroke (IS) in young women. The RATIO (Risk of Arterial Thrombo

  2. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study

    DEFF Research Database (Denmark)

    O'Donnell, M.J.; Serpault, Damien Xavier; Xiufeng, Liu;

    2010-01-01

    Background The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these ris......; 18.8%, 11.2-29.7); regular physical activity (0.69, 0.53-0.90; 285%, 14 5-48.5); diabetes mellitus (1.36, 1.10-1.68; 5.0%, 2.6-9.5); alcohol intake (1.51, 1.18-1.92 for more than 30 drinks per month or binge drinking; 3 - 8%, 0.9-14.4); psychosocial stress (1.30, 1.06-1.60; 46%, 2...... an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90.3% (85.3-93.7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were...

  3. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol

    OpenAIRE

    Boss, H M; Van Schaik, S M; Deijle, I A; de Melker, E C; van den Berg, B T J; Scherder, E.J.A.; Bosboom, W M J; Weinstein, H C; van den Berg - Vos, R.M.

    2014-01-01

    Introduction Patients with transient ischaemic attack (TIA) or stroke are at risk for cognitive impairment and dementia. Currently, there is no known effective strategy to prevent this cognitive decline. Increasing evidence exists that physical exercise is beneficial for cognitive function. However, in patients with TIA or stroke who are at risk of cognitive impairment and dementia, only a few trials have been conducted. In this study, we aim to investigate whether a physical exercise program...

  4. Stroke: advances in medical therapy and acute stroke intervention.

    Science.gov (United States)

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

  5. Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.

    LENUS (Irish Health Repository)

    Tobin, W O

    2013-02-01

    The impact of changing antiplatelet therapy on thrombin generation potential in patients with ischaemic cerebrovascular disease (CVD) is unclear. We assessed patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Thrombin generation was assessed in platelet poor plasma. Ninety-one patients were recruited. Twenty-four were initially assessed on no antiplatelet therapy, and then after 14d (N = 23) and 90d (N = 8) on aspirin monotherapy; 52 were assessed on aspirin monotherapy, and after 14 and 90 days on aspirin and dipyridamole combination therapy; 21 patients were assessed on aspirin and after 14 days (N = 21) and 90 days (N = 19) on clopidogrel. Peak thrombin generation and endogenous thrombin potential were reduced at 14 and 90 days (p ≤ 0.04) in the overall cohort. We assessed the impact of individual antiplatelet regimens on thrombin generation parameters to investigate the cause of this effect. Lag time and time-to-peak thrombin generation were unchanged at 14 days, but reduced 90 days after commencing aspirin (p ≤ 0.009). Lag time, peak thrombin generation and endogenous thrombin potential were reduced at both 14 and 90 days after adding dipyridamole to aspirin (p ≤ 0.01). Lag time was reduced 14 days after changing from aspirin to clopidogrel (p = 0.045), but this effect was not maintained at 90 days (p = 0.2). This pilot study did not show any consistent effects of commencing aspirin, or of changing from aspirin to clopidogrel on thrombin generation potential during follow-up. The addition of dipyridamole to aspirin led to a persistent reduction in peak and total thrombin generation ex vivo, and illustrates the diverse, potentially beneficial, newly recognised \\'anti-coagulant\\' effects of dipyridamole in ischaemic CVD.

  6. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS)

    DEFF Research Database (Denmark)

    Bath, Philip M W; Woodhouse, Lisa; Scutt, Polly;

    2015-01-01

    BACKGROUND: High blood pressure is associated with poor outcome after stroke. Whether blood pressure should be lowered early after stroke, and whether to continue or temporarily withdraw existing antihypertensive drugs, is not known. We assessed outcomes after stroke in patients given drugs...... to lower their blood pressure. METHODS: In our multicentre, partial-factorial trial, we randomly assigned patients admitted to hospital with an acute ischaemic or haemorrhagic stroke and raised systolic blood pressure (systolic 140-220 mm Hg) to 7 days of transdermal glyceryl trinitrate (5 mg per day......·91-1·13; p=0·83), and with continue versus stop antihypertensive drugs OR was 1·05 (0·90-1·22; p=0·55). INTERPRETATION: In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show...

  7. EVALUATION OF RISK FACTORS IN ACUTE STROKE

    Directory of Open Access Journals (Sweden)

    Putta

    2015-03-01

    Full Text Available Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for c erebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Re sults: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension followed by smoking, diabetes mellitus. More common pathology was infarction. Conclusion: Com mon risk factors for acute stroke are hypertension, smoking, diabetes mellitus, alcoholism, obesity, cardiac disease. Stroke was confirmed by CT scan of brain.

  8. Stroke Statistics in Korea: Part II Stroke Awareness and Acute Stroke Care, A Report from the Korean Stroke Society and Clinical Research Center For Stroke

    OpenAIRE

    Hong, Keun-Sik; Bang, Oh Young; Kim, Jong S.; Heo, Ji Hoe; Yu, Kyung-Ho; Bae, Hee-Joon; Kang, Dong-Wha; Lee, Jin Soo; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Yoon, Byung-Woo

    2013-01-01

    The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public's knowledge of stroke definition, risk factors, warning signs, and act on stroke generally remains low. According to studies using open-ended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than...

  9. Translating research into practice: Lessons from trials of thrombolysis in acute stroke

    Directory of Open Access Journals (Sweden)

    Venables Graham

    2008-01-01

    Full Text Available There exist individual, institutional and national barriers to change, none more so than when introducing new therapies into medical practice especially those that involve organizational change. This paper, presented as an address to the joint meeting of the Association of British Neurologists and the Indian Academy of Neurology in October 2007, explores these barriers in the context of the instruction of thrombolytic therapy for patients with acute ischaemic stroke and suggests how they might be overcome using evidence from relevant clinical trials and observational studies.

  10. The role of neuroimaging in acute stroke

    Directory of Open Access Journals (Sweden)

    Dhamija Rajinder

    2008-01-01

    Full Text Available Background: There is a need for early recognition, diagnosis, and therapy in patients with acute stroke. The most important therapies are thrombolysis or aspirin in hyperacute ischemic stroke and, for secondary prevention, antiplatelet agents, statins, ACE inhibitors (for lowering blood pressure, warfarin, and carotid endarterectomy or stenting. Imaging technology has a crucial role to play in the diagnosis and treatment of stroke. In recent years, significant advances have been made due to the availability of physiological imaging using a variety of techniques, ranging from computerized tomography (CT to magnetic resonance imaging (MRI, which enable clinicians to define brain anatomy and physiology in greater detail than ever before. Objective: In this article we discuss the imaging techniques currently available for patients with acute stroke, with an emphasis on the utility of these techniques for diagnosis and refining patient selection for early interventions. This is placed in the context of the needs of developing countries . Discussion: Although noncontrast CT (NCCT remains the most commonly used imaging modality to differentiate between ischemic and hemorrhagic stroke, to identify early CT changes, and to rule out stroke mimics, it is not sensitive enough to identify the infarct core or the mechanism of ischemic stroke. MRI, including magnetic resonance angiography (MRA, is the most useful imaging modality for the evaluation of acute stroke; it provides information about the mechanism as well as the vascular territory of the stroke. MRI also provides complete information about the status of tissue through diffusion-weighted imaging (DWI and about arterial patency by means of MRA. DWI shows acute lesions within minutes of onset of ischemia, while MRA can evaluate extracranial as well as intracranial vessels Evaluation of the proportion of penumbra vs infarcted tissue is another issue to be considered when instituting thrombolysis, and

  11. Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava.

    Science.gov (United States)

    Lindeberg, S; Lundh, B

    1993-03-01

    On the island of Kitava, Trobriand Islands, Papua New Guinea, a subsistence lifestyle, uninfluenced by western dietary habits, is still maintained. Tubers, fruit, fish and coconut are dietary staples. Of the total population, 1816 subjects were estimated to be older than 3 years and 125 to be 60-96 years old. The frequencies of spontaneous sudden death, exertion-related chest pain, hemiparesis, aphasia and sudden imbalance were assessed by semi-structured interviews in 213 adults aged 20-96. Resting electrocardiograms (ECG's) were recorded in 119 males and 52 females. No case corresponding to stroke, sudden death or angina pectoris was described by the interviewed subjects. Minnesota Code (MC) items 1-5 occurred in 14 ECG's with no significant relation to age, gender or smoking. ST items (MC 4.2 and 4.3) were found in two females and Q items (MC 1.1.2, 1.3.2 and 1.3.3) in three males. Stroke and ischaemic heart disease appear to be absent in this population.

  12. Primary prevention of ischaemic stroke in atrial fibrillation: new oral anticoagulant drugs for all?

    Science.gov (United States)

    Foley, James; Kirchhof, Paulus; Lip, Gregory Y H

    2014-05-01

    Atrial fibrillation (AF) confers a 4.5% risk of stroke per year. The risk of stroke increases with various risk factors and until recently, warfarin has been the gold standard of thromboembolism prophylaxis in AF for many years. The dosage of warfarin requires regular adjustment dependent on the INR, to keep within a narrow therapeutic range of 2.0- 3.0. The INR can be altered by concomitant drugs, foods and alcohol and requires inconvenient blood monitoring. Underanticoagulation places patients at risk of stroke, whilst over-anticoagulation confers significant bleeding risk. Consequently approximately half who would benefit from oral anticoagulation do not have it prescribed. Novel oral anticoagulants with predictable pharmacokinetics and improved efficacy and safety profiles are currently being developed for stroke prevention in AF. Three novel oral anticoagulants have just completed Phase III trials for stroke prevention, all with impressive results; the direct thrombin inhibitor, dabigatran and the oral factor Xa inhibitors, rivaroxaban and apixaban. PMID:24846226

  13. CT perfusion in acute stroke

    International Nuclear Information System (INIS)

    Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it

  14. Radiological strategy in acute stroke in children

    International Nuclear Information System (INIS)

    The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

  15. Acute Stroke Management in Patients Taking Dabigatran

    NARCIS (Netherlands)

    Brouns, Raf; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; De Raedt, Sylvie; Uyttenboogaart, Maarten; Luijckx, Gert-Jan; Jochmans, Kristin; De Keyser, Jacques

    2012-01-01

    Dabigatran etexilate is emerging as an alternative for vitamin K antagonists, but evidence-based guidelines for management of intracerebral hemorrhage and acute ischemic stroke in patients taking this drug are nonexistent. This review summarizes current knowledge on key pharmacological features and

  16. Radiological strategy in acute stroke in children

    Energy Technology Data Exchange (ETDEWEB)

    Paonessa, Amalia [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)], E-mail: apaonessa7@hotmail.com; Limbucci, Nicola [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy); Tozzi, Elisabetta [Dept. of Pediatrics, University Hospital ' S. Salvatore' , L' Aquila (Italy); Splendiani, Alessandra; Gallucci, Massimo [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)

    2010-04-15

    The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

  17. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Sacco, Ralph L; Yusuf, Salim;

    2008-01-01

    -DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed...... with the mini-mental state examination (MMSE) score at 4 weeks after randomisation and at the penultimate visit. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov, number NCT00153062. FINDINGS: 20,332 patients (mean age 66 years) were randomised and followed-up for a median...... of patients with dementia among the treatment groups. There were no significant differences in the proportion of patients with cognitive impairment or dementia among the treatment groups. INTERPRETATION: Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke were...

  18. Bowel Function in Acute Stroke Patients

    OpenAIRE

    Yi, Jin Hwa; Chun, Min Ho; Kim, Bo Ryun; Han, Eun Young; Park, Ji Young

    2011-01-01

    Objective To investigate factors related to bowel function and colon motility in acute stroke patients. Method Fifty-one stroke patients (29 males, mean age 63.4±13.6 years, onset 13.4±4.8 days) were recruited and divided into two groups: constipation (n=25) and non-constipation (n=26) groups. We evaluated the amount of intake, voiding function, concomitant swallowing problem and colon transit time (CTT) using radio-opaque markers for ascending, descending and rectosigmoid colons. The Adapted...

  19. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  20. Lesion locations influencing baseline severity and early recovery in ischaemic stroke

    NARCIS (Netherlands)

    Bentley, P.; Kumar, G.; Rinne, P.; Buddha, S.; Kallingal, J.; Hookway, C.; Sharma, P.; Mehta, A.; Beckmann, C.F.

    2014-01-01

    Background and purpose: Strokes caused by lesions to certain brain areas are associated with poor outcome, which is important both prognostically and to understand the neural basis for recovery. However, lesion anatomy associations with outcome may occur because of effects on baseline severity rathe

  1. Plasticity in the Developing Brain: Intellectual, Language and Academic Functions in Children with Ischaemic Perinatal Stroke

    Science.gov (United States)

    Ballantyne, Angela O.; Spilkin, Amy M.; Hesselink, John; Trauner, Doris A.

    2008-01-01

    The developing brain has the capacity for a great deal of plasticity. A number of investigators have demonstrated that intellectual and language skills may be in the normal range in children following unilateral perinatal stroke. Questions have been raised, however, about whether these skills can be maintained at the same level as the brain…

  2. Long-term cognitive outcome of ischaemic stroke in young adults

    NARCIS (Netherlands)

    Bruijn, M.A. de; Synhaeve, N.E.; Rijsbergen, M.W. van; Leeuw, F.E. de; Jansen, B.P.; Kort, P.L.M. de

    2014-01-01

    BACKGROUND: Long-term prognosis in terms of cognition in young stroke patients is very important because these patients usually still have a long life expectancy and rather extensive daily life demands. However, little is known on cognitive deficits in these patients. We aimed to evaluate cognitive

  3. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R;

    2012-01-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients...

  4. Diffusion and perfusion correlates of the {sup 18}F-MISO PET lesion in acute stroke: pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Alawneh, Josef A.; Marrapu, S.T.; Jensen-Kondering, Ulf; Morris, Rhiannon S.; Jones, P.S. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Moustafa, Ramez R. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Ain Shams University, Department of Neurology, Cairo (Egypt); Aigbirhio, Franklin I.; Fryer, Tim D.; Carpenter, T.A. [University of Cambridge, Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge (United Kingdom); Warburton, Elizabeth A. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Stroke Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom); Baron, Jean-Claude [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Universite Paris Descartes, INSERM U894, Centre Hospitalier Sainte-Anne, Paris (France)

    2014-04-15

    Mapping the ischaemic penumbra in acute stroke is of considerable clinical interest. For this purpose, mapping tissue hypoxia with {sup 18}F-misonidazole (FMISO) PET is attractive, and is straightforward compared to {sup 15}O PET. Given the current emphasis on penumbra imaging using diffusion/perfusion MR or CT perfusion, investigating the relationships between FMISO uptake and abnormalities with these modalities is important. According to a prospective design, three patients (age 54-81 years; admission NIH stroke scale scores 16-22) with an anterior circulation stroke and extensive penumbra on CT- or MR-based perfusion imaging successfully completed FMISO PET, diffusion-weighted imaging and MR angiography 6-26 h after stroke onset, and follow-up FLAIR to map the final infarction. All had persistent proximal occlusion and a poor outcome despite thrombolysis. Significant FMISO trapping was defined voxel-wise relative to ten age-matched controls and mapped onto coregistered maps of the penumbra and irreversibly damaged ischaemic core. FMISO trapping was present in all patients (volume range 18-119 ml) and overlapped mainly with the penumbra but also with the core in each patient. There was a significant (p ≤ 0.001) correlation in the expected direction between FMISO uptake and perfusion, with a sharp FMISO uptake bend around the expected penumbra threshold. FMISO uptake had the expected overlap with the penumbra and relationship with local perfusion. However, consistent with recent animal data, our study suggests FMISO trapping may not be specific to the penumbra. If confirmed in larger samples, this preliminary finding would have potential implications for the clinical application of FMISO PET in acute ischaemic stroke. (orig.)

  5. Minocycline Development for Acute Ischemic Stroke

    OpenAIRE

    Fagan, Susan C.; Cronic, Lydia E.; Hess, David C.

    2011-01-01

    Minocycline, a tetracycline antibiotic, has shown anti-inflammatory, anti-apoptotic, and neuroprotective effects in many models of cerebral ischemia and neurodegenerative disease. Its high penetration of the blood–brain barrier, good safety profile, and delayed therapeutic window make it an ideal candidate for use in stroke. In animal models, minocycline reduced infarct size and improved neurologic outcome when administered acutely, with similar neuroprotective benefits seen following delayed...

  6. NADPH Oxidase as a Therapeutic Target for Neuroprotection against Ischaemic Stroke: Future Perspectives

    Directory of Open Access Journals (Sweden)

    Carli L. Roulston

    2013-04-01

    Full Text Available Oxidative stress caused by an excess of reactive oxygen species (ROS is known to contribute to stroke injury, particularly during reperfusion, and antioxidants targeting this process have resulted in improved outcomes experimentally. Unfortunately these improvements have not been successfully translated to the clinical setting. Targeting the source of oxidative stress may provide a superior therapeutic approach. The NADPH oxidases are a family of enzymes dedicated solely to ROS production and pre-clinical animal studies targeting NADPH oxidases have shown promising results. However there are multiple factors that need to be considered for future drug development: There are several homologues of the catalytic subunit of NADPH oxidase. All have differing physiological roles and may contribute differentially to oxidative damage after stroke. Additionally, the role of ROS in brain repair is largely unexplored, which should be taken into consideration when developing drugs that inhibit specific NADPH oxidases after injury. This article focuses on the current knowledge regarding NADPH oxidase after stroke including in vivo genetic and inhibitor studies. The caution required when interpreting reports of positive outcomes after NADPH oxidase inhibition is also discussed, as effects on long term recovery are yet to be investigated and are likely to affect successful clinical translation.

  7. NADPH Oxidase as a Therapeutic Target for Neuroprotection against Ischaemic Stroke: Future Perspectives.

    Science.gov (United States)

    McCann, Sarah K; Roulston, Carli L

    2013-01-01

    Oxidative stress caused by an excess of reactive oxygen species (ROS) is known to contribute to stroke injury, particularly during reperfusion, and antioxidants targeting this process have resulted in improved outcomes experimentally. Unfortunately these improvements have not been successfully translated to the clinical setting. Targeting the source of oxidative stress may provide a superior therapeutic approach. The NADPH oxidases are a family of enzymes dedicated solely to ROS production and pre-clinical animal studies targeting NADPH oxidases have shown promising results. However there are multiple factors that need to be considered for future drug development: There are several homologues of the catalytic subunit of NADPH oxidase. All have differing physiological roles and may contribute differentially to oxidative damage after stroke. Additionally, the role of ROS in brain repair is largely unexplored, which should be taken into consideration when developing drugs that inhibit specific NADPH oxidases after injury. This article focuses on the current knowledge regarding NADPH oxidase after stroke including in vivo genetic and inhibitor studies. The caution required when interpreting reports of positive outcomes after NADPH oxidase inhibition is also discussed, as effects on long term recovery are yet to be investigated and are likely to affect successful clinical translation. PMID:24961415

  8. The Christchurch earthquake stroke incidence study.

    Science.gov (United States)

    Wu, Teddy Y; Cheung, Jeanette; Cole, David; Fink, John N

    2014-03-01

    We examined the impact of major earthquakes on acute stroke admissions by a retrospective review of stroke admissions in the 6 weeks following the 4 September 2010 and 22 February 2011 earthquakes. The control period was the corresponding 6 weeks in the previous year. In the 6 weeks following the September 2010 earthquake there were 97 acute stroke admissions, with 79 (81.4%) ischaemic infarctions. This was similar to the 2009 control period which had 104 acute stroke admissions, of whom 80 (76.9%) had ischaemic infarction. In the 6 weeks following the February 2011 earthquake, there were 71 stroke admissions, and 61 (79.2%) were ischaemic infarction. This was less than the 96 strokes (72 [75%] ischaemic infarction) in the corresponding control period. None of the comparisons were statistically significant. There was also no difference in the rate of cardioembolic infarction from atrial fibrillation between the study periods. Patients admitted during the February 2011 earthquake period were less likely to be discharged directly home when compared to the control period (31.2% versus 46.9%, p=0.036). There was no observable trend in the number of weekly stroke admissions between the 2 weeks leading to and 6 weeks following the earthquakes. Our results suggest that severe psychological stress from earthquakes did not influence the subsequent short term risk of acute stroke, but the severity of the earthquake in February 2011 and associated civil structural damages may have influenced the pattern of discharge for stroke patients.

  9. Dabigatran etexilate: management in acute ischemic stroke.

    Science.gov (United States)

    Javedani, Parisa P; Horowitz, B Zane; Clark, Wayne M; Lutsep, Helmi L

    2013-03-01

    A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thrombus. Suction thrombectomy achieved flow through the inferior division of the artery. Computed tomography of the head showed possible intracranial hemorrhage, and dabigatran reversal was attempted with prothrombin complex concentrate and recombinant factor VIIa. Coagulation studies before administration of the reversal blood products showed a partial thromboplastin time of 30.3 seconds; 1 hour after administration, the partial thromboplastin time was 28.5 seconds. No evidence of intracranial hemorrhage was apparent on repeated computed tomography scans of the brain. He was discharged with aspirin and warfarin and a stroke score of 8. (American Journal of Critical Care. 2013;22:169-176) The use of long-term oral anticoagulation is indicated for prevention of cardiac thromboembolism in selected patients with nonvalvular atrial fibrillation. With the emergence of new potent oral agents- including the selective direct thrombin inhibitor dabigatran-clinicians must become familiar with the management of such patients. In this case report, we present a man who had an acute ischemic stroke while taking dabigatran and discuss the medical decision making regarding management issues. PMID:23455868

  10. Enhanced ex vivo inhibition of platelet function following addition of dipyridamole to aspirin after transient ischaemic attack or ischaemic stroke: first results from the TRinity AntiPlatelet responsiveness (TrAP) study.

    LENUS (Irish Health Repository)

    Tobin, William Oliver

    2012-02-01

    Ex vivo dipyridamole \\'non-responsiveness\\' has not been extensively studied in ischaemic cerebrovascular disease. Platelet surface marker expression, leucocyte-platelet complex formation and inhibition of platelet function at high shear stress as detected by the PFA-100(R) Collagen-Adenosine-diphosphate (C-ADP) and Collagen-Epinephrine cartridges was assessed in 52 patients within 4 weeks of transient ischaemic attack (TIA) or ischaemic stroke on aspirin, and then 14 d (14 d) and >90 d (90 d) after adding dipyridamole. A novel definition of \\'Dipyridamole non-responsiveness\\' was used. The median C-ADP closure time increased following addition of dipyridamole, remained elevated at 90 d (P <\\/= 0.03), and was unaffected by aspirin dose. 59% at 14 d and 56% at 90 d were \\'dipyridamole non-responders\\' on the PFA-100. The proportion of non-responders at 14 and 90 d was similar (P= 0.9). Compared with baseline (4.6%), median monocyte-platelet complexes increased at 14 d (5.0%, P= 0.03) and 90 d (4.9%, P= 0.04). Low C-ADP closure times were associated with increased monocyte-platelet complexes at 14 d (r= -0.32, P= 0.02) and 90 d (r= -0.33, P = 0.02). Monocyte-platelet complexes increased in the subgroup of dipyridamole non-responders on the PFA-100 (P<\\/= 0.045), but not in responders (P >\\/= 0.5), at 14 and 90 d versus baseline. Additional inhibition of platelet function has been detected with the PFA-100 when dipyridamole is added to aspirin. Elevated monocyte-platelet complexes may contribute to ex vivo dipyridamole non-responsiveness.

  11. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack;

    2016-01-01

    in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal...

  12. Neurorehabilitation after Stroke

    Directory of Open Access Journals (Sweden)

    Rüdiger J. Seitz

    2013-08-01

    Full Text Available Recovery from ischaemic stroke is determined in the acute phase by the lesion impact of ischaemia and subsequently, by functional and structural network changes in the spared brain tissue. Neurorehabilitation supports the restitution of function using repetitive, learning-based and, more recently, technology-based training strategies.

  13. Radiologic manifestations of focal cerebral hyperemia in acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Skriver, E B; Herning, M

    1991-01-01

    In 16 acute stroke patients with focal cerebral hyperemia angiography and regional cerebral blood flow (rCBF) were studied 1 to 4 days post stroke. CT was performed twice with and without contrast enhancement 3 +/- 1 days and 16 +/- 4 days post stroke. Angiographic evidence of focal cerebral hype...

  14. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke.

    Science.gov (United States)

    Ruthirago, Doungporn; Julayanont, Parunyou; Tantrachoti, Pakpoom; Kim, Jongyeol; Nugent, Kenneth

    2016-01-01

    Cardiac arrhythmias and electrocardiogram (ECG) abnormalities occur frequently but are often underrecognized after strokes. Acute ischemic and hemorrhagic strokes in some particular area of brain can disrupt central autonomic control of the heart, precipitating cardiac arrhythmias, ECG abnormalities, myocardial injury and sometimes sudden death. Identification of high-risk patients after acute stroke is important to arrange appropriate cardiac monitoring and effective management of arrhythmias, and to prevent cardiac morbidity and mortality. More studies are needed to better clarify pathogenesis, localization of areas associated with arrhythmias and practical management of arrhythmias and abnormal ECGs after acute stroke. PMID:26802767

  15. Diagnosis of acute stroke by MRI and biomarker

    International Nuclear Information System (INIS)

    Stroke Care Unit (SCU) in Tokushima University Hospital has been opened since November 1999. Patients with acute stroke in SCU were diagnosed by stroke MRI and biomarker immediately after their admission. Diffusion MRI could diagnose the ultra-acute ischemic and hemorrhagic lesion except brainstem ischemic lesion within 3 hrs after onset. Diffusion-Perfusion mismatch was useful to indicate intra-arterial thrombolytic therapy. 3T-MRI was introduced since March 2004, and it can measured functional MR spectroscopy and tractography more quickly compared to 1. 5T-MRI. Plasma oxidized low density lipoprotein (LDL) in patients with acute cerebral infarction was significantly higher than that in healthy control and it became peak level during 3-5 day after stroke onset. In conclusion, stroke MRI and plasma oxidized LDL are useful diagnostic tools for acute stroke. (author)

  16. Evolving Role of Endovascular Treatment of Acute Ischemic Stroke

    OpenAIRE

    Ciccone, Alfonso; del Zoppo, Gregory J.

    2014-01-01

    The perceived advantages of endovascular treatment for acute ischemic stroke in terms of recanalization, the multimodal and targeted approaches, and perhaps the more permissive rules on devices than on medications for their licensing favored the assumption that endovascular treatment is superior to intravenous thrombolysis for acute treatment of ischemic stroke, and its adoption in more advanced stroke centers. However, this assumption has been questioned by recent clinical trial experience s...

  17. Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment

    OpenAIRE

    Kim, Bum Joon; Kang, Hyun Goo; Kim, Hye-Jin; Ahn, Sung-Ho; Kim, Na Young; Warach, Steven; Kang, Dong-Wha

    2014-01-01

    Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke,...

  18. Angiotensin receptor blockade in acute stroke. The Scandinavian Candesartan Acute Stroke Trial

    DEFF Research Database (Denmark)

    Sandset, Else Charlotte; Murray, Gordon; Boysen, Gudrun;

    2010-01-01

    . Secondary outcome variables: Secondary effect variables include • the Barthel index (functional status) • EuroQol (quality of life) and • Mini-mental state examination (cognition) at 6-months • Health economic costs during the first 6-months FUNDING: The Scandinavian Candesartan Acute Stroke Trial receives......-European countries: Norway, Sweden, Denmark, Belgium, Germany, Poland, Lithuania, Estonia and Finland. STUDY OUTCOMES: There are two co-primary effect variables: • Functional status at 6-months, measured by the modified Rankin Scale, and • vascular death, myocardial infarction or stroke during the first 6-months...

  19. Management of acute stroke: impact of registration studies.

    Science.gov (United States)

    Adams, Harold P

    2010-09-01

    Stroke is a life-threatening or life-changing disease that is expensive in health care costs and lost productivity. Stroke also is a leading cause of human suffering. While the risk of stroke may be reduced with advances in prevention, recent advances in acute care can limit the consequences of stroke. In particular, the success of reperfusion therapies including intra-arterial interventions and intravenous administration of thrombolytic agents means that some patients with stroke may be cured. Still, the time window for effective treatment of stroke is relatively short. As a result, modern stroke management requires the close collaboration of the public, health care providers, administrators, insurance companies, and the government. Potential strategies to extend modern stroke care to as many patients as possible include 1) educational programs to train community emergency medical service personnel and physicians, 2) development of stroke care plans at community hospitals, 3) an integrated community-comprehensive stroke center program based on consultation, and telemedicine. The goal is to have a highly integrated approach to provide emergency treatment of the stroke that provides key emergency treatment, including intravenous administration of thrombolytic medications, at a community hospital (primary stroke center) with evacuation to a comprehensive stroke center that has resources and expertise that are not available in the primary stroke center. Taiwan is an ideal location for the development of such regional stroke programs.

  20. Dyslipidemia and Outcome in Patients with Acute Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    XU Tian; ZHANG Jin Tao; YANG Mei; ZHANG Huan; LIU Wen Qing; KONG Yan; XU Tan; ZHANG Yong Hong

    2014-01-01

    ObjectiveTo study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. MethodsData about 1 568 patients with acute ischemic stroke werecollected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale (NIHSS) >10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. ResultsThe serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 (1.259, 7.214)/2.655 (1.298, 5.43), 3.157(1.306, 7.631)/3.405(1.621, 7.154), and 0.482 (0.245, 0.946)/0.51 (0.282, 0.921), respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke (chi-square=8.235, P=0.411). ConclusionSerum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.

  1. Associations of serum n-3 and n-6 PUFA and hair mercury with the risk of incident stroke in men: the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD).

    Science.gov (United States)

    Daneshmand, Roya; Kurl, Sudhir; Tuomainen, Tomi-Pekka; Virtanen, Jyrki K

    2016-05-28

    PUFA have been associated with lower risk of CVD, but less is known about their association with stroke risk. Fish, a major source of n-3 PUFA, may also contain methylmercury, which has been associated with higher risk of CVD and attenuation of the benefits of long-chain n-3 PUFA. We investigated the associations of serum n-3 and n-6 PUFA and hair Hg with risk of stroke in men. A total of 1828 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 years and free of CVD at baseline in 1984-1989 were studied. Cox regression models were used for the analyses. During the mean follow-up of 21·2 years, 202 stroke cases occurred, of which 153 were ischaemic strokes. After adjustment for age and examination year, the only statistically significant association among the n-3 and n-6 PUFA was observed between the n-3 PUFA α-linolenic acid and risk of haemorrhagic stroke (hazard ratio in the highest v. the lowest quartile 0·33; 95 % CI 0·13, 0·86; P trend=0·03). However, further adjustments attenuated the association to statistically non-significant. Hair Hg was not associated with stroke risk, but among those with hair Hg above the median level, higher serum long-chain n-3 PUFA concentrations were associated with a higher risk of ischaemic stroke. In our cohort of men, serum n-3 or n-6 PUFA or hair Hg were not associated with stroke risk; however, the interaction between Hg and long-chain n-3 PUFA with regard to ischaemic stroke risk warrants further investigation.

  2. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.

    Science.gov (United States)

    Hsieh, Fang-I; Jeng, Jiann-Shing; Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  3. The predictive value of the Boston Acute Stroke Imaging Scale (BASIS in acute ischemic stroke patients among Chinese population.

    Directory of Open Access Journals (Sweden)

    Yuanqi Zhao

    Full Text Available OBJECTIVE: Evaluate the predictive value of Boston Acute Stroke Imaging Scale (BASIS in acute ischemic stroke in Chinese population. METHODS: This was a retrospective study. 566 patients of acute ischemic stroke were classified as having a major stroke or minor stroke based on BASIS. We compared short-term outcome (death, occurrence of complications, admission to intensive care unit [ICU] or neurological intensive care unit [NICU], long-term outcome (death, recurrence of stroke, myocardial infarction, modified Rankin scale and economic index including in-hospital cost and length of hospitalization. Continuous variables were compared by using the Student t test or Kruskal-Wallis test. Categorical variables were tested with the Chi square test. Cox regression analysis was applied to identify whether BASIS was the independent predictive variable of death. RESULTS: During hospitalization, 9 patients (4.6% died in major stroke group while no patients died in minor stroke group (p < 0.001, 12 patients in the major stroke group and 5 patients in minor stroke group were admitted to ICU/NICU (p = 0.001. There were more complications (cerebral hernia, pneumonia, urinary tract infection in major stroke group than minor stroke group (p<0.05. Meanwhile, the average cost of hospitalization in major stroke group was 3,100 US$ and 1,740 US$ in minor stroke group (p<0.001; the average length of stay in major and minor stroke group was 21.3 days and 17.3 days respectively (p<0.001. Results of the follow-up showed that 52 patients (26.7% died in major stroke group while 56 patients (15.1% died in minor stroke group (P<0.001. 62.2% of the patients in major stroke group and 80.4% of the patients in minor stroke group were able to live independently (P = 0.002. The survival analysis showed that patients with major stroke had 80% higher of risk of death than patients with minor stroke even after adjusting traditional atherosclerotic factors and NIHSS at baseline (HR

  4. The use of telemedicine in the management of acute stroke.

    Science.gov (United States)

    Rubin, Mark N; Demaerschalk, Bart M

    2014-01-01

    Cerebrovascular disease, including acute ischemic stroke, remains a major public health problem in the US and throughout the world. There has been a concerted effort to apply evidence-based practices to stroke care to improve primary and secondary prevention as well as poststroke outcomes. Geography and workforce shortages contribute to a disparity in stroke care, however, among the substantial proportion of the US population that lives outside the reach of an acute stroke-ready hospital or a primary or comprehensive stroke center. In an attempt to combat the rural-to-urban disparity and expand the availability of best stroke practices, Levine and Gorman proposed the development of telemedical outreach for acute stroke evaluation and management, which they called "telestroke." Since then, the practice of telestroke has been found to have a high interrater agreement with a bedside assessment of the National Institutes of Health Stroke Scale score, to enhance correct thrombolysis decision making as compared with telephone-only consultation, and to be cost-effective. In light of these findings and the perception of benefit by acute stroke providers and patients, there has been growing interest in and a rapid expansion of telestroke networks in the US and internationally. There are legal and financial barriers to more widespread use of telemedicine in general, including telestroke. Further research is needed to understand the potential merits of telestroke infrastructure for the many phases of stroke care including poststroke hospitalization, prevention of complications, enhancing secondary prevention, and education of patients and providers.

  5. AGE AND GENDER DIFFERENCES IN ACUTE STROKE HOSPITAL PATIENTS.

    Science.gov (United States)

    Kes, Vanja Bašić; Jurašić, Miljenka-Jelena; Zavoreo, Iris; Lisak, Marijana; Jelec, Vjekoslav; Matovina, Lucija Zadro

    2016-03-01

    Stroke is the second leading cause of death and the most important cause of adult disability worldwide and in Croatia. In the past, stroke was almost exclusively considered to be a disease of the elderly; however, today the age limit has considerably lowered towards younger age. The aim of this study was to determine age and gender impact on stroke patients in a Croatian urban area during one-year survey. The study included all acute stroke patients admitted to our Department in 2004. A compiled stroke questionnaire was fulfilled during hospitalization by medical personnel on the following items: stroke risk factors including lifestyle habits (smoking and alcohol), pre-stroke physical ability evaluation, stroke evolution data, laboratory and computed tomography findings, outcome data and post-stroke disability assessment. Appropriate statistical analysis of numerical and categorical data was performed at the level of p adult stroke group. Older stroke patients had worse disability at hospital discharge and women had worse disabilities at both stroke onset and hospital discharge, probably due to older age at stroke onset. Younger patients recovered better, while older patients had to seek secondary medical facilities more often, as expected. The most important in-hospital laboratory findings in young stroke patients were elevated lipid levels, while older patients had elevated serum glucose and C-reactive protein. Stroke onset in younger patients most often presented with sudden onset headache; additionally, onset seizure was observed more frequently than expected. Stroke risk factor analysis showed that women were more prone to hypertension, chronic heart failure and atrial fibrillation, whereas men had carotid disease more frequently, were more often smokers and had higher alcohol intake. Additionally, age analysis showed that heart conditions and smoking were more prevalent among older stroke patients. In conclusion, considerable differences were established

  6. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  7. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

    Science.gov (United States)

    Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A.; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010–2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006–08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, pcollaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  8. Computed tomography in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Loevblad, Karl-Olof [HUG-Geneva University Hospital, Geneva University Medical School, Department of Neuroradiology, Department of Imaging and Medical Informatics, Geneva (Switzerland); Baird, Alison E. [SUNY Downstate Medical Center, Cerebrovascular Disease and Stroke, 450 Clarkson Avenue, Box 1213, Brooklyn, NY (United States)

    2010-03-15

    Stroke remains the third most important cause of mortality in industrialized countries; this has prompted research for improvements in both diagnostic and therapeutic strategies for patients with signs of acute cerebral ischemia. Over the last decade, there has been a parallel in progress in techniques in both diagnostic and therapeutic options. While previously only used for excluding hemorrhage, imaging now has the possibility to detect ischemia, vascular occlusion, as well as detect tissue at risk in one setting. It should also allow to monitor treatment and predict/exclude therapeutic complications. Parallel to advances in magnetic resonance imaging of stroke, computed tomography has improved immensely over the last decade due to the development of CT scanners that are faster and that allow to acquire studies such as CT perfusion or CT angiography in a reliable way. CT can detect many signs that might help us detect impending signs of massive infarction, but we still lack the experience to use these alone to prevent a patient from benefitting from possible therapy. (orig.)

  9. Endovascular treatment of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Paramdeep Singh

    2013-01-01

    Full Text Available Early recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

  10. Technetium-99m HMPAO SPET in acute supratentorial ischaemic infraction, expressing deficits as millilitre of zero perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Dierckx, R.A. [Univ. Hospital of Ghent (Belgium). Dept. of Nuclear Medicine and Radiotherapy]|[Antwerp Univ. (Belgium). Lab. of Neurochemistry and Behavior, Born-Bunge Foundation UIA; Dobbeleir, A. [Middelheim Hospital, Antwerp (Belgium). Dept. of Nuclear Medicine; Pickut, B.A. [Middelheim Hospital, Antwerp (Belgium). Dept. of Neurology; Timmermans, L. [Middelheim Hospital, Antwerp (Belgium). Dept. of Neurology; Dierckx, I. [Middelheim Hospital, Antwerp (Belgium). Dept. of Radiology; Vervaet, A. [Middelheim Hospital, Antwerp (Belgium). Dept. of Nuclear Medicine; Vandevivere, J. [Middelheim Hospital, Antwerp (Belgium). Dept. of Nuclear Medicine; Deberdt, W. [UCB Pharma NV (Belgium); Deyn, P.P. de [Middelheim Hospital, Antwerp (Belgium). Dept. of Neurology]|[Antwerp Univ. (Belgium). Lab. of Neurochemistry and Behavior, Born-Bunge Foundation UIA

    1995-05-01

    A comparative interim analysis was performed of clinical parameters, computed tomographic (CT) scan results and {sup 99m}Tc-HMPAO (SPET)-findings obtained within 12 h of acute supratentorial ischaemic infarction. First, the applicability for SPET semiquantification in this study of the ``method of Mountz``, simultaneously accounting for extent and degrees of hypoperfusion, was considered. Next, the relative contributions of perfusion SPET and CT scan in the acute stage of ischaemic infarction were compared in 27 patients (mean age 68.8 years). Finally, the correlation of SPET lesions with clinical parameters at onset was evaluated. The method of Mountz represents a workable, accurate virtual parameter, with the assumption that the contralateral brain region remains uninvolved. Because of inconstant distribution of activities in the brain, the method can only be applied slice by sclice and not on the total global volume. While the mean delay since the onset of symptomatology was approximately 7 h for both SPET and CT scan, SPET showed lesions concordant with the clinical neurological findings in 100% and CT scan in only 48%. One could hypothesize that SPET examinations performed later would show larger functional defects, because of the development of additional functional changes secondary to biochemical alterations. However, in this regard no statistically significant differences were found between two subproups, taking the median of delay before SPET examination as cut-off. Finally, when comparing the volumes of SPET lesions during the acute stage with clinical parameters, a statistically significant correlation (P<0.01) was found with the Orgogozo Scale scores describing the neurological deficit, but not with the Glasgow Coma Scale or Frenchay Aphasia Screening Test scores obtained on admittance. (orig./MG)

  11. Gender differences in acute stroke: Istanbul medical school stroke registry

    OpenAIRE

    Nilüfer Yesilot; Bahar Aksay Koyuncu; Oguzhan Çoban; Rezzan Tuncay; Sara Zarko Bahar

    2011-01-01

    Background : We aimed to investigate gender differences in Turkish stroke patients. Material and Methods : Demographics, risk factors, clinical and etiologic subtypes, laboratory findings, clinical course, and in-hospital prognosis of 1 522 patients with ischemic stroke (IS) and 320 patients with intracerebral hemorrhage prospectively registered in the Istanbul Medical School Stroke Registry (1994-2004) were analyzed separately. Results : The mean age of IS patients was higher in females (n :...

  12. Validation and Recalibration of Two Multivariable Prognostic Models for Survival and Independence in Acute Stroke.

    Directory of Open Access Journals (Sweden)

    Julius Sim

    Full Text Available Various prognostic models have been developed for acute stroke, including one based on age and five binary variables ('six simple variables' model; SSVMod and one based on age plus scores on the National Institutes of Health Stroke Scale (NIHSSMod. The aims of this study were to externally validate and recalibrate these models, and to compare their predictive ability in relation to both survival and independence.Data from a large clinical trial of oxygen therapy (n = 8003 were used to determine the discrimination and calibration of the models, using C-statistics, calibration plots, and Hosmer-Lemeshow statistics. Methods of recalibration in the large and logistic recalibration were used to update the models.For discrimination, both models functioned better for survival (C-statistics between .802 and .837 than for independence (C-statistics between .725 and .735. Both models showed slight shortcomings with regard to calibration, over-predicting survival and under-predicting independence; the NIHSSMod performed slightly better than the SSVMod. For the most part, there were only minor differences between ischaemic and haemorrhagic strokes. Logistic recalibration successfully updated the models for a clinical trial population.Both prognostic models performed well overall in a clinical trial population. The choice between them is probably better based on clinical and practical considerations than on statistical considerations.

  13. Validation and Recalibration of Two Multivariable Prognostic Models for Survival and Independence in Acute Stroke

    Science.gov (United States)

    Teece, Lucy; Dennis, Martin S.; Roffe, Christine

    2016-01-01

    Introduction Various prognostic models have been developed for acute stroke, including one based on age and five binary variables (‘six simple variables’ model; SSVMod) and one based on age plus scores on the National Institutes of Health Stroke Scale (NIHSSMod). The aims of this study were to externally validate and recalibrate these models, and to compare their predictive ability in relation to both survival and independence. Methods Data from a large clinical trial of oxygen therapy (n = 8003) were used to determine the discrimination and calibration of the models, using C-statistics, calibration plots, and Hosmer-Lemeshow statistics. Methods of recalibration in the large and logistic recalibration were used to update the models. Results For discrimination, both models functioned better for survival (C-statistics between .802 and .837) than for independence (C-statistics between .725 and .735). Both models showed slight shortcomings with regard to calibration, over-predicting survival and under-predicting independence; the NIHSSMod performed slightly better than the SSVMod. For the most part, there were only minor differences between ischaemic and haemorrhagic strokes. Logistic recalibration successfully updated the models for a clinical trial population. Conclusions Both prognostic models performed well overall in a clinical trial population. The choice between them is probably better based on clinical and practical considerations than on statistical considerations. PMID:27227988

  14. Anticoagulation for the Acute Management of Ischemic Stroke

    OpenAIRE

    Robinson, Austin A.; Ikuta, Kevin; Soverow, Jonathan

    2014-01-01

    Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circums...

  15. S-100AND#946; protein as a biomarker in acute hemorrhagic stroke

    OpenAIRE

    Omkar Prasad Baidya; Susmita Chaudhuri; Ksh Gomti Devi

    2014-01-01

    Acute hemorrhagic stroke, a subtype of acute stroke is one of the leading causes of death and disability throughout the world. At present, the diagnosis of acute hemorrhagic stroke is mainly based on Computer Tomography (CT) or Magnetic Resonance Imaging (MRI) but till now no biomarkers are routinely used in acute hemorrhagic stroke management. This article is a critical and descriptive review on the role of S100β protein as a biomarker in acute hemorrhagic stroke. Plasma S-100β lev...

  16. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke.

    Science.gov (United States)

    Arboix, Adrià

    2015-05-16

    Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients. PMID:25984516

  17. STUDY OF RISK FACTORS AND CLINICAL PROFILE OF ACUTE STROKE

    Directory of Open Access Journals (Sweden)

    Tomar

    2014-05-01

    Full Text Available `INTRODUCTION: Stroke is the third leading cause of death in developed countries after cardiovascular disease and cancer. In India Community Surveys have shown a crude prevalence rate for hemiplegia 200 per 1, 00, 000 population. It accounts for nearly 1.5% of all urban admissions, 4.5 % of all medical and about 20% of neurological cases. AIMS AND OBJECTIVE: Identification of risk factors and evaluation of clinical profile of acute stroke. MATERIAL AND METHOD: INCLUSION CRITERIA: Cases of acute stoke admitted in SGMH hospital were selected for the study. EXCLUSION CRITERIA: Brain injury cases, infective, neoplastic cases producing stroke were excluded. RESULTS: Stroke was more common in male, 58 % patients were male and 42% patients were female. It was more common in 5th and 6th decade. Most common etiology was infarction. Most common risk factor was hypertension followed by smoking. In addition to limb weakness, headache and vomiting were most common presenting symptoms followed by convulsion. These symptoms were more common in hemorrhagic stroke. Right sided hemiplegia was more common than left sided. Middle cerebral artery was involved in majority of cases in atherothrombotic stroke whereas basal ganglion was most common site of bleed in hemorrhagic stroke. Coma and mortality were more in hemorrhagic stroke. CONCLUSION: The risk factors and clinical profile of acute stroke in India are similar to that of Western countries. Common risk factors are hypertension, smoking, diabetes mellitus and hyperlipidemia

  18. An associative Brain-Computer-Interface for acute stroke patients

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Stevenson, Andrew James Thomas; Aliakbaryhosseinabadi, Susan;

    2017-01-01

    An efficient innovative Brain-Computer-Interface system that empowers chronic stroke patients to control an artificial activation of their lower limb muscle through task specific motor intent has been tested in the past. In the current study it was applied to acute stroke patients. The system...

  19. Thrombolysis in Acute Ischemic Stroke: The North American Experience

    Institute of Scientific and Technical Information of China (English)

    Justin Zivin

    2000-01-01

    @@It has been understood for well over a century that clots in cerebral arteries are the usual cause of strokes, but it was only in 1995 that the techniques necessary to reduce neurologic damage were identified. A lengthy and difficult effort was required to prove the value of acute stroke thrombolysis and this has become controversial topic.

  20. CT angiography and CT perfusion in acute ischemic stroke

    NARCIS (Netherlands)

    Seeters, T. van

    2016-01-01

    CT angiography and CT perfusion are used in patients with acute ischemic stroke for diagnostic purposes and to select patients for treatment. In this thesis, the reproducibility of CT angiography and CT perfusion is examined, the additional value of CT angiography and CT perfusion for stroke outcome

  1. Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

    OpenAIRE

    Rico, María

    2016-01-01

    María Rico, Laura Martinez-Rodriguez, Davinia Larrosa-Campo, Sergio Calleja Neurology Department, Central University Hospital of Asturias, Oviedo, Spain Background: Stroke mimics may account for up to 30% of all acute stroke consultations. However, in the emergency setting, accurate diagnosis is not always possible.Methods: Case report and review of the literature.Results: A 73-year-old woman was admitted to the emergency department with acute aphasia and...

  2. Neither in vivo MRI nor behavioural assessment indicate therapeutic efficacy for a novel 5HT1A agonist in rat models of ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Modo Michel M

    2009-07-01

    Full Text Available Abstract Background 5HT1A agonists have previously been shown to promote recovery in animal models of stroke using ex vivo outcome measures which have raised the hopes for a potential clinical implementation. The purpose of this study was to evaluate the potential neuroprotective properties of a novel 5HT1A agonist DU123015 in 2 different models of transient focal ischaemic stroke of varying severities using both in vivo neuroimaging and behavioural techniques as primary outcome measures. For these studies, the NMDA receptor antagonist MK-801 was also utilized as a positive control to further assess the effectiveness of the stroke models and techniques used. Results In contrast to MK-801, no significant therapeutic effect of DU123015 on lesion volume in either the distal MCAo or intraluminal thread model of stroke was found. MK-801 significantly reduced lesion volume in both models; the mild distal MCAo condition (60 min ischaemia and the intraluminal thread model, although it had no significant impact upon the lesion size in the severe distal MCAo condition (120 min ischaemia. These therapeutic effects on lesion size were mirrored on a behavioural test for sensory neglect and neurological deficit score in the intraluminal thread model. Conclusion This study highlights the need for a thorough experimental design to test novel neuroprotective compounds in experimental stroke investigations incorporating: a positive reference compound, different models of focal ischaemia, varying the duration of ischaemia, and objective in vivo assessments within a single study. This procedure will help us to minimise the translation of less efficacious compounds.

  3. Pharmaceutical Sponsorship Bias Influences Thrombolytic Literature in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Ryan P Radecki

    2011-05-01

    Full Text Available Background: The efficacy of thrombolytic therapy for acute ischemic stroke remains controversial in Emergency Medicine and has not been fully endorsed by either the American College of Emergency Physicians or the American Academy of emergency medicine. A growing recognition exists of the influence of pharmaceutical sponsorship on the reported findings of published clinical trials. Sponsorship bias has been suggested as a potential criticism of the literature and guidelines favoring thrombolytic therapy. Objective: The objective of this study is to review the most influential literature regarding thrombolytic therapy for acute ischemic stroke and document the presence or absence of pharmaceutical sponsorship. Methods: A publication-citation analysis was performed to identify the most frequently cited articles pertaining to thrombolytic therapy for acute ischemic stroke. Identified articles were reviewed for disclosures of pharmaceutical funding. Results: Of the 20 most-cited articles pertaining to thrombolytic therapy for acute stroke, 17 (85% disclosed pharmaceutical sponsorship. These disclosures range from general sponsorship to direct employment of authors by pharmaceutical companies. Conclusion: An overwhelming predominance of the most influential literature regarding thrombolytic therapy for acute ischemic stroke is susceptible to sponsorship bias. This potential bias may provide a basis for physician concern regarding the efficacy and safety of thrombolytic therapy. Further, large, independent, placebo-controlled studies may be required to guide therapy and professional guidelines definitively for acute ischemic stroke. [West J Emerg Med. 2011;12(4:435–441.

  4. Risk of stroke after acute myocardial infarction among Chinese

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Following an acute myocardial infarction (AMI), patients have an increased risk of stroke. Estimates of risk are mainly derived from AMI treatment trials or secondary prevention studies. The reported incidence of stroke in Caucasians in the early phase after AMI ranged from 0.5% to 2.5%.1-3 Similar assessment of risk in the Chinese population is lacking. As thrombolytic therapy becomes standard treatment for AMI, there is concern that there may be an increase in haemorrhagic stroke complicating AMI treatment, especially since haemorrhagic stroke is more common in Asian populations.

  5. Wernicke's Encephalopathy Mimicking Acute Onset Stroke Diagnosed by CT Perfusion

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    Alok Bhan

    2014-01-01

    Full Text Available Background. Metabolic syndromes such as Wernicke’s encephalopathy may present with a sudden neurological deficit, thus mimicking acute onset stroke. Due to current emphasis on rapid admission and treatment of acute stroke patients, there is a significant risk that these stroke mimics may end up being treated with thrombolysis. Rigorous clinical and radiological skills are necessary to correctly identify such metabolic stroke mimics, in order to avoid doing any harm to these patients due to the unnecessary use of thrombolysis. Patient. A 51-year-old Caucasian male was admitted to our hospital with suspicion of an acute stroke due to sudden onset dysarthria and unilateral facial nerve paresis. Clinical examination revealed confusion and dysconjugate gaze. Computed tomography (CT including a CT perfusion (CTP scan revealed bilateral thalamic hyperperfusion. The use of both clinical and radiological findings led to correctly diagnosing Wernicke’s encephalopathy. Conclusion. The application of CTP as a standard diagnostic tool in acute stroke patients can improve the detection of stroke mimics caused by metabolic syndromes as shown in our case report.

  6. Perfusion Angiography in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Fabien Scalzo

    2016-01-01

    Full Text Available Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF and cerebral blood volume (CBV, mean transit time (MTT, time-to-peak (TTP, and Tmax, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis. The method is tested on 66 acute ischemic stroke patients treated with thrombectomy and/or tissue plasminogen activator (tPA and also evaluated on an estimation task with known ground truth. This novel imaging tool provides unique insights into flow mechanisms that cannot be observed directly in DSA sequences and might be used to evaluate the impact of endovascular interventions more precisely.

  7. Perfusion Angiography in Acute Ischemic Stroke.

    Science.gov (United States)

    Scalzo, Fabien; Liebeskind, David S

    2016-01-01

    Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA) remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF) and cerebral blood volume (CBV), mean transit time (MTT), time-to-peak (TTP), and T max, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis. The method is tested on 66 acute ischemic stroke patients treated with thrombectomy and/or tissue plasminogen activator (tPA) and also evaluated on an estimation task with known ground truth. This novel imaging tool provides unique insights into flow mechanisms that cannot be observed directly in DSA sequences and might be used to evaluate the impact of endovascular interventions more precisely. PMID:27446232

  8. Gender differences in acute stroke: Istanbul medical school stroke registry

    Directory of Open Access Journals (Sweden)

    Nilüfer Yesilot

    2011-01-01

    Full Text Available Background : We aimed to investigate gender differences in Turkish stroke patients. Material and Methods : Demographics, risk factors, clinical and etiologic subtypes, laboratory findings, clinical course, and in-hospital prognosis of 1 522 patients with ischemic stroke (IS and 320 patients with intracerebral hemorrhage prospectively registered in the Istanbul Medical School Stroke Registry (1994-2004 were analyzed separately. Results : The mean age of IS patients was higher in females (n : 751 (P<0.0001. In males, smoking, ischemic heart disease, peripheral arterial disease, posterior circulation syndromes, and strokes due to large-artery atherosclerosis were more common (P<0.0001 for each. Prestroke disability, atrial fibrillation (P<0.0001, hypertension (P=0.041, modified Rankin Scale (mRS 3-5 at admission (P<0.0001, total anterior circulation syndrome (P<0.0001, and cardioembolic stroke (P<0.0001 were more frequent in females. Female gender was an independent predictor of poor outcome (mRS 3-6. Conclusion : Gender differences were observed exclusively in patients with IS. Although our patients were younger than those reported, gender differences were similar.

  9. Protocol for Past BP: a randomised controlled trial of different blood pressure targets for people with a history of stroke of transient ischaemic attack (TIA in primary care

    Directory of Open Access Journals (Sweden)

    Greenfield Sheila

    2010-08-01

    Full Text Available Abstract Background Blood pressure (BP lowering in people who have had a stroke or transient ischaemic attack (TIA leads to reduced risk of further stroke. However, it is not clear what the target BP should be, since intensification of therapy may lead to additional adverse effects. PAST BP will determine whether more intensive BP targets can be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life. Methods/Design This is a randomised controlled trial (RCT in patients with a past history of stroke or TIA. Patients will be randomised to two groups and will either have their blood pressure (BP lowered intensively to a target of 130 mmHg systolic, (or by 10 mmHg if the baseline systolic pressure is between 125 and 140 mmHg compared to a standard group where the BP will be reduced to a target of 140 mmHg systolic. Patients will be managed by their practice at 1-3 month intervals depending on level of BP and followed-up by the research team at six monthly intervals for 12 months. 610 patients will be recruited from approximately 50 general practices. The following exclusion criteria will be applied: systolic BP The primary outcome will be change in systolic BP over twelve months. Secondary outcomes include quality of life, adverse events and cardiovascular events. In-depth interviews with 30 patients and 20 health care practitioners will be undertaken to investigate patient and healthcare professionals understanding and views of BP management. Discussion The results of this trial will inform whether intensive blood pressure targets can be achieved in people who have had a stroke or TIA in primary care, and help determine whether or not further research is required before recommending such targets for this population. Trial Registration ISRCTN29062286

  10. Cerebral lactate production and blood flow in acute stroke

    DEFF Research Database (Denmark)

    Henriksen, O; Gideon, P; Sperling, B;

    1992-01-01

    Eight stroke patients were examined serially in the acute phase and 1 week and 2-4 weeks after stroke with water-suppressed proton magnetic resonance spectroscopy. The time courses of lactate level and regional cerebral blood flow were studied. A high lactate level was found in the acute phase...... that follows reperfusion. The amount of lactate present in the acute phase reflects the severity of ischemia in the affected region. The lactate level was still above normal in the subacute phase with hyperemia, suggesting lactate production through aerobic glycolysis. Thus, the lactate level in the subacute...

  11. RAAS and stress markers in acute ischemic stroke

    DEFF Research Database (Denmark)

    Back, C.; Thiesen, K L; Olsen, Karsten Skovgaard;

    2015-01-01

    . RESULTS: The acute systolic blood pressure was significantly increased, 148 (141-168) vs 140 (130-147) mmHg post-stroke. Angiotensin I, renin and aldosterone levels were significantly lower, angiotensin II was unchanged, and ACE activity was higher in the acute phase compared to post-stroke. No...... differences in RAAS were detected between jugular and cubital plasma levels. Jugular venous plasma levels of epinephrine and cortisol were elevated in the acute phase compared to cubital levels (P < 0.05). CONCLUSION: Increased epinephrine and cortisol levels in the jugular vein blood may reflect a higher...

  12. Health Impact Assessment for Second-Hand Smoke Exposure in Germany—Quantifying Estimates for Ischaemic Heart Diseases, COPD, and Stroke

    Directory of Open Access Journals (Sweden)

    Florian Fischer

    2016-02-01

    Full Text Available Evidence of the adverse health effects attributable to second-hand smoke (SHS exposure is available. This study aims to quantify the impact of SHS exposure on ischaemic heart diseases (IHD, chronic obstructive pulmonary diseases (COPD, and stroke in Germany. Therefore, this study estimated and forecasted the morbidity for the three outcomes in the German population. Furthermore, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model. Overall 687,254 IHD cases, 231,973 COPD cases, and 288,015 stroke cases were estimated to be attributable to SHS exposure in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic aging. Assuming a total eradication of SHS exposure beginning in 2014 leads to an estimated reduction of 50% in cases, compared to the reference scenario in 2040 for all three diseases. The results highlight the relevance of SHS exposure because it affects several chronic disease conditions and has a major impact on the population’s health. Therefore, public health campaigns to protect non-smokers are urgently needed.

  13. Potential microRNA biomarkers for acute ischemic stroke.

    Science.gov (United States)

    Zeng, Ye; Liu, Jing-Xia; Yan, Zhi-Ping; Yao, Xing-Hong; Liu, Xiao-Heng

    2015-12-01

    Acute ischemic stroke is a significant cause of high morbidity and mortality in the aging population globally. However, current therapeutic strategies for acute ischemic stroke are limited. Atherosclerotic plaque is considered an independent risk factor for acute ischemic stroke. To identify biomarkers for carotid atheromatous plaque, bioinformatics analysis of the gene microarray data of plaque and intact tissue from individuals was performed. Differentially expressed genes (DEGs) were identified using the Multtest and Limma packages of R language, including 56 downregulated and 69 upregulated DEGs. Enriched microRNA (miRNA or miR) DEGs networks were generated using WebGestalt software and the STRING databases, and the miRNAs were validated using serum from acute ischemic stroke patients with reverse transcription quantitative PCR (RT‑qPCR). Four confirmed differentially expressed miRNAs (miR‑9, ‑22, ‑23 and ‑125) were associated with 28 upregulated DEGs, and 7 miRNAs (miR‑9, ‑30, ‑33, ‑124, ‑181, ‑218 and ‑330) were associated with 25 downregulated DEGs. Gene ontology (GO) function suggested that the confirmed miRNA‑targeted DEGs predominantly associated with signal transduction, the circulatory system, biological adhesion, striated muscle contraction, wound healing and the immune system. The confirmed miRNA‑targeted genes identified serve as potential therapeutic targets for acute ischemic stroke. PMID:26459744

  14. Role of transcranial Doppler ultrasonography in acute stroke

    Directory of Open Access Journals (Sweden)

    Sharma Vijay

    2008-01-01

    Full Text Available Background: Transcranial Doppler (TCD ultrasonography is the only noninvasive examination that provides a reliable evaluation of intracranial blood flow patterns in real-time, adding physiological information to the anatomical information obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring both in acute emergency settings as well as over prolonged periods; it has a high temporal resolution, making it ideal for studying dynamic cerebrovascular responses. Objective: To define the role of TCD in the evaluation of patients with acute ischemic stroke. Material and methods: We have analyzed the existing literature on the protocols for performing TCD in the evaluation of patients with acute cerebral ischemia. Extended applications of TCD in enhancing intravenous thrombolysis in acute stroke, emboli monitoring, right-to-left shunt detection, and vasomotor reactivity have also been described. Results: In acute cerebral ischemia, TCD is capable of providing rapid information about the hemodynamic status of the cerebral circulation, monitoring recanalization in real-time and, additionally, has a potential for enhancing tissue plasminogen activator (TPA-induced thrombolysis. Extended applications of TCD make it an important and valuable tool for evaluating stroke mechanisms, for planning and monitoring treatment, and for determining prognosis. Discussion and conclusion: TCD has an established clinical value in the diagnostic workup of stroke patients and is suggested as one of the essential components of a comprehensive stroke center. TCD is also an evolving ultrasound method with increasing diagnostic value and a therapeutic potential in cerebral ischemia

  15. Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials

    Directory of Open Access Journals (Sweden)

    Philip M. Bath

    2016-01-01

    Full Text Available Background. Nitric oxide (NO donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4–6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD from completed trials. Methods. Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional outcome was assessed using the modified Rankin scale (mRS and death, by time to randomisation. Secondary outcomes included measures of disability, mood, and quality of life. Results. Five trials (4,197 participants were identified, all involving glyceryl trinitrate (GTN. Compared with control, GTN lowered blood pressure by 7.4/3.3 mmHg. At day 90, GTN did not alter any clinical measures. However, in 312 patients randomised within 6 hours of stroke onset, GTN was associated with beneficial shifts in the mRS (odds ratio (OR 0.52, 95% confidence interval (CI 0.34–0.78 and reduced death (OR 0.32, 95% CI 0.14–0.78. Conclusions. NO donors do not alter outcome in patients with recent stroke. However, when administered within 6 hours, NO donors might improve outcomes in both ischaemic and haemorrhagic stroke.

  16. Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials

    Science.gov (United States)

    Bath, Philip M.; Woodhouse, Lisa; Krishnan, Kailash; Anderson, Craig; Berge, Eivind; Ford, Gary A.; Robinson, Thompson G.; Saver, Jeffrey L.; Sprigg, Nikola; Wardlaw, Joanna M.; in Acute Stroke Collaboration (BASC), Blood pressure

    2016-01-01

    Background. Nitric oxide (NO) donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4–6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD) from completed trials. Methods. Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional outcome was assessed using the modified Rankin scale (mRS) and death, by time to randomisation. Secondary outcomes included measures of disability, mood, and quality of life. Results. Five trials (4,197 participants) were identified, all involving glyceryl trinitrate (GTN). Compared with control, GTN lowered blood pressure by 7.4/3.3 mmHg. At day 90, GTN did not alter any clinical measures. However, in 312 patients randomised within 6 hours of stroke onset, GTN was associated with beneficial shifts in the mRS (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.34–0.78) and reduced death (OR 0.32, 95% CI 0.14–0.78). Conclusions. NO donors do not alter outcome in patients with recent stroke. However, when administered within 6 hours, NO donors might improve outcomes in both ischaemic and haemorrhagic stroke. PMID:27190674

  17. PISA. The effect of paracetamol (acetaminophen and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

    Directory of Open Access Journals (Sweden)

    Kappelle Jaap

    2002-03-01

    Full Text Available Abstract Background During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may improve their functional outcome. Previously, we studied the effect of high dose (6 g daily and low dose (3 g daily paracetamol (acetaminophen in a randomised placebo-controlled trial of 75 patients with acute ischemic stroke. In the high-dose paracetamol group, mean body temperature at 12 and 24 hours after start of treatment was 0.4°C lower than in the placebo group. The effect of ibuprofen, another potent antipyretic drug, on body-core temperature in normothermic patients has not been studied. Aim The aim of the present trial is to study the effects of high-dose paracetamol and ibuprofen on body temperature in patients with acute ischaemic stroke, and to study the safety of these treatments. Design Seventy-five (3 × 25 patients with acute ischaemic stroke confined to the anterior circulation will be randomised to treatment with either: 400 mg ibuprofen, 1000 mg acetaminophen, or with placebo 6 times daily during 5 days. Body-temperatures will be measured with a rectal electronic thermometer at the start of treatment and after 24 hours. An infrared tympanic thermometer will be used to monitor body temperature at 2-hour intervals during the first 24 hours and at 12-hour intervals thereafter. The primary outcome measure will be rectal temperature at 24 hours after the start of treatment. The study results will be analysed on an intent-to-treat basis, but an on-treatment analysis will also be performed. No formal interim analysis will be carried out.

  18. Use of Antithrombotics after Hemorrhagic Transformation in Acute Ischemic Stroke

    OpenAIRE

    Kim, Joon-Tae; Heo, Suk-Hee; Park, Man-Seok; Chang, Jane; Choi, Kang-Ho; Cho, Ki-Hyun

    2014-01-01

    Backgrounds There have been neither appropriate guidelines nor clinical studies about the use of antithrombotics after hemorrhagic transformation (HT). We sought to find whether the use of antithrombotics after hemorrhagic infarction might be associated with aggravation of HT and neurological deterioration. Methods This retrospective study included prospectively registered consecutive patients with acute ischemic stroke and HT in our tertiary stroke center. We focused on the hemorrhagic infar...

  19. Factors delaying hospital arrival of patients with acute stroke

    OpenAIRE

    Ashraf, V. V.; Maneesh, M; Praveenkumar, R.; Saifudheen, K; Girija, A. S.

    2015-01-01

    Background: Low rates of thrombolysis for ischemic stroke in India and other developing countries have been attributed to delays in presentation to the hospital. Materials and Methods: A prospective study was carried out during a 12-month period ending December 2012 in the department of Neurology, Malabar Institute of Medical Sciences, Kerala, India, to look for the factors contributing to delay in hospital arrival of patients with acute stroke. Patients and or their relatives were interviewe...

  20. Acute Phase Reactants and Ischemic Stroke

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    Mustafa Sahan

    2010-04-01

    Full Text Available Cerebrovascular diseases which called as stroke causes severe mortality and morbidity. Stoke is the third cause of death and first cause of the sequela among in its disorder group. Stroke with a 80-85% has the most frequency and the most cause of death in among the neurological disorders. Besides its lethal effects, sequela of stroke also cause physiological problems on individuals, families and social groups, it also brings some economic problems. [Archives Medical Review Journal 2010; 19(2.000: 85-140

  1. Safe intravenous thrombolysis in acute stroke despite treatment with rivaroxaban.

    Science.gov (United States)

    Bornkamm, Katharina; Harloff, Andreas

    2014-11-01

    Data regarding intravenous thrombolysis in stroke patients receiving new oral anticoagulant drugs (nOAC) is sparse. In the near future, however, an increasing number of patients with atrial fibrillation will suffer recurrent stroke despite treatment with nOAC. This will cause a significant therapeutic dilemma as thrombolysis is contraindicated under such circumstances. We describe an 81-year-old patient presenting with acute ischemic stroke who was successfully treated with intravenous thrombolysis despite ongoing treatment with rivaroxaban. Our case report indicates that thrombolysis under nOAC may be safe under certain conditions and emphasizes the importance of establishing and performing specific anticoagulation tests for nOAC. PMID:24938385

  2. Circulating MicroRNAs as Biomarkers of Acute Stroke

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    Sugunavathi Sepramaniam

    2014-01-01

    Full Text Available MicroRNAs have been identified as key regulators of gene expression and thus their potential in disease diagnostics, prognosis and therapy is being actively pursued. Deregulation of microRNAs in cerebral pathogenesis has been reported to a limited extent in both animal models and human. Due to the complexity of the pathology, identifying stroke specific microRNAs has been a challenge. This study shows that microRNA profiles reflect not only the temporal progression of stroke but also the specific etiologies. A panel of 32 microRNAs, which could differentiate stroke etiologies during acute phase was identified and verified using a customized TaqMan Low Density Array (TLDA. Furthermore we also found 5 microRNAs, miR-125b-2*, -27a*, -422a, -488 and -627 to be consistently altered in acute stroke irrespective of age or severity or confounding metabolic complications. Differential expression of these 5 microRNAs was also observed in rat stroke models. Hence, their specificity to the stroke pathology emphasizes the possibility of developing these microRNAs into accurate and useful tools for diagnosis of stroke.

  3. Highly sensitive troponin T in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, J K; Ueland, T; Aukrust, P;

    2012-01-01

    in decedents than in survivors. After adjustment for stroke severity, C-reactive protein, age, NT-proBNP and prior heart and/or renal failure, hsTnT levels were not a significant predictor of long-term all-cause or cardiovascular mortality. Conclusion: Elevated levels of hsTnT are frequently present......Background: Newly developed troponin assays have superior diagnostic and prognostic performance in acute coronary syndrome (ACS), when compared to conventional troponin assays; however, highly sensitive troponin has not been evaluated in patients with acute ischemic stroke. Methods: Highly...... sensitive troponin T (hsTnT) was measured daily during the first 4 days in 193 consecutive patients with acute ischemic stroke without overt ACS or atrial fibrillation. The patients were previously tested normal with a fourth-generation TnT assay. The patients were followed for 47 months, with all...

  4. Serum Uric Acid Level among Acute Stroke Patients.

    Science.gov (United States)

    Mohsin, M; Das, S N; Haque, M F; Shikha, S S; Bhuiyan, A S; Saha, P L; Das, B R; Chowdhury, M; Jahan, M K; Rahman, M M

    2016-04-01

    Stroke is one of the leading causes of death and disability in developed as well as developing countries like Bangladesh. Elevated serum uric acid levels may predict an increased risk for cerebro-vascular (CV) events including stroke. Aim of the study was to measure the serum uric acid level among stroke patients and determine the relationship between serum uric acid level and stroke. This descriptive, cross-sectional study was carried out in Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh to measure serum uric acid level among 102 stroke patients in a period of one year by using non-probability sampling procedure. Finally, collected data were analyzed using SPSS software Version 17.0. It was observed that the mean age of patients was 60.87±8.05 years, of them 80(78.43%) patients were male and the rest 22(21.57%) were female. About 66(64.70%) of respondents were in age group 60 years and above, while 36(35.30%) were in age group 59 years and below. At least 23(22.55%) of stroke patients had elevated serum uric acid with a mean serum uric acid level of 5.18mg/dl and standard deviation 1.26mg/dl. About 23(27.38%) patients in ischemic stroke had elevated serum uric acid whereas 18(100%) patients in hemorrhagic stroke had normal uric acid level. Uric acid level was elevated in ischemic stroke than haemorrhagic stroke patients (p<0.001). High uric acid level may be considered as a risk factor in patients with acute ischemic stroke. PMID:27277350

  5. Clinical profile of acute hemorrhagic stroke patients: a study in tertiary care hospital in Northern India

    OpenAIRE

    Omkar P. Baidya; Sunita Tiwari; Kauser Usman

    2014-01-01

    Background: Acute hemorrhagic stroke, a subtype of acute stroke is one of the leading cause of death and major cause of morbidity and mortality throughout the world. The incidence of acute hemorrhagic stroke is increasing with gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and various cardiac problems. This study had been conducted with an objective to study the risk factors and clinical presentation of acute hemorrhagic stroke patients in north-Indian population...

  6. Acute stroke magnetic resonance imaging: current status and future perspective.

    Science.gov (United States)

    Kloska, Stephan P; Wintermark, Max; Engelhorn, Tobias; Fiebach, Jochen B

    2010-03-01

    Cerebral stroke is one of the most frequent causes of permanent disability or death in the western world and a major burden in healthcare system. The major portion is caused by acute ischemia due to cerebral artery occlusion by a clot. The minority of strokes is related to intracerebral hemorrhage or other sources. To limit the permanent disability in ischemic stroke patients resulting from irreversible infarction of ischemic brain tissue, major efforts were made in the last decade. To extend the time window for thrombolysis, which is the only approved therapy, several imaging parameters in computed tomography and magnetic resonance imaging (MRI) have been investigated. However, the current guidelines neglect the fact that the portion of potentially salvageable ischemic tissue (penumbra) is not dependent on the time window but the individual collateral blood flow. Within the last years, the differentiation of infarct core and penumbra with MRI using diffusion-weighted images (DWI) and perfusion imaging (PI) with parameter maps was established. Current trials transform these technical advances to a redefined patient selection based on physiological parameters determined by MRI. This review article presents the current status of MRI for acute stroke imaging. A special focus is the ischemic stroke. In dependence on the pathophysiology of cerebral ischemia, the basic principle and diagnostic value of different MRI sequences are illustrated. MRI techniques for imaging of the main differential diagnoses of ischemic stroke are mentioned. Moreover, perspectives of MRI for imaging-based acute stroke treatment as well as monitoring of restorative stroke therapy from recent trials are discussed.

  7. Deviation of eyes and head in acute cerebral stroke

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    Ilg UJ

    2006-06-01

    Full Text Available Abstract Background It is a well-known phenomenon that some patients with acute left or right hemisphere stroke show a deviation of the eyes (Prévost's sign and head to one side. Here we investigated whether both right- and left-sided brain lesions may cause this deviation. Moreover, we studied the relationship between this phenomenon and spatial neglect. In contrast to previous studies, we determined not only the discrete presence or absence of eye deviation with the naked eye through clinical inspection, but actually measured the extent of horizontal eye-in-head and head-on-trunk deviation. In further contrast, measurements were performed early after stroke onset (1.5 days on average. Methods Eye-in-head and head-on-trunk positions were measured at the bedside in 33 patients with acute unilateral left or right cerebral stroke consecutively admitted to our stroke unit. Results Each single patient with spatial neglect and right hemisphere lesion showed a marked deviation of the eyes and the head to the ipsilesional, right side. The average spontaneous gaze position in this group was 46° right, while it was close to the saggital body midline (0° in the groups with acute left- or right-sided stroke but no spatial neglect as well as in healthy subjects. Conclusion A marked horizontal eye and head deviation observed ~1.5 days post-stroke is not a symptom associated with acute cerebral lesions per se, nor is a general symptom of right hemisphere lesions, but rather is specific for stroke patients with spatial neglect. The evaluation of the patient's horizontal eye and head position thus could serve as a brief and easy way helping to diagnose spatial neglect, in addition to the traditional paper-and-pencil tests.

  8. Ischaemic colitis and lung infiltrates caused by extramedullary haematopoiesis in a patient with an acute erythroid leukaemia following polycythaemia vera

    NARCIS (Netherlands)

    Brada, SJL; de Wolf, JTM; Poppema, S; Vellenga, E

    1998-01-01

    A patient with 'spent' polycythaemia vera showed extensive extramedullary haematopoiesis (EMH) in non-haematopoietic tissue clinically resulting in an ischaemic colitis and respiratory symptoms due to lung infiltrates. On laboratory investigation, the EMH also included immature erythroblasts due to

  9. Thrombolysis in acute ischemic stroke: where and when?

    Directory of Open Access Journals (Sweden)

    Giuseppe Micieli

    2007-12-01

    Full Text Available The therapy of acute ischemic stroke remains an open challenge for the clinicians and is closely connected to the ready acknowledgment of symptoms, to the promptness of the instrumental diagnosis and consequently to the rapidity of the pharmacological intervention. Although several studies have validated the effectiveness and the safety profileof the intravenous fibrinolytic treatment, the number of patients who benefit of such therapeutic opportunity is still too little. This data is partially due to the delay within patients arrive to the hospital and to the doubts of the physicians on the possible collateral effects, but it is also related to logistic and organizational-managerial problematic of the patient with acute stroke.These last ones mainly derive from the deficiency on the national territory of dedicated structures (Stroke Unit, from the absence of operative connections between the 118-service and the Stroke Unit, from the delay of the neurologist calling in the emergency room that does not allow an adapted diagnostic evaluation of the ischemic event. The spread of the intravenous fibrinolysis must therefore necessarily pass through the creation of participation protocols between hospitals with stroke unit and primary aid, and between department of emergency/ urgency and staff of the stroke unit also previewing the creation of professional figures like those of the urgency neurologist that could have the full right of the management and the treatment of cerebral ischemic pathology.

  10. Intravenous thrombolysis is unsafe in stroke due to infective endocarditis.

    Science.gov (United States)

    Brownlee, W J; Anderson, N E; Barber, P A

    2014-02-01

    Embolic stroke is the most common neurological complication of infective endocarditis and a major source of morbidity and mortality. Septic embolism is considered a contraindication to intravenous thrombolysis in patients with ischaemic stroke because of concerns over an increased risk of intracranial haemorrhage. We describe a patient with occult endocarditis who was treated with thrombolysis for acute stroke and review other cases reported in the literature.

  11. Pseudoradial Nerve Palsy Caused by Acute Ischemic Stroke

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    Hassan Tahir MD

    2016-07-01

    Full Text Available Pseudoperipheral palsy has been used to characterize isolated monoparesis secondary to stroke. Isolated hand nerve palsy is a rare presentation for acute cerebral stroke. Our patient presented with clinical features of typical peripheral radial nerve palsy and a normal computed tomography scan of the head, which, without a detailed history and neurological examination, could have been easily misdiagnosed as a peripheral nerve lesion deferring further investigation for a stroke. We stress the importance of including cerebral infarction as a critical differential diagnosis in patients presenting with sensory-motor deficit in an isolated peripheral nerve pattern. A good history and physical exam can differentiate stroke from peripheral neuropathy as the cause of radial nerve palsy.

  12. STUDY OF C-REACTIVE PROTEIN IN ACUTE ISCHEMIC STROKE

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    Medhini

    2014-06-01

    Full Text Available : Ischemic stroke is the 3rd leading cause of death after AMI and cancer. Stroke is also the leading cause of hospital admission causing disability. The study was based on 100 patients with ischemic stroke admitted to the JJM Medical College, Davangere. This study was done to estimate the role of C-reactive protein as a marker of acute inflammation following ischemic stroke and also to determine, its prognostic role, by assessing the functional outcome of patient using modified Barthel index scoring (ADL. Patients with CRP 6 mg/dl suffered severe disease with poor functional outcome. P value <0.05, significant, suggests CRP is a good tool for prognostic indicator

  13. Intensive treadmill training in the acute phase after ischemic stroke

    DEFF Research Database (Denmark)

    Strømmen, Anna M; Christensen, Thomas; Jensen, Kai

    2016-01-01

    The aim of the study was to (a) assess the feasibility of intensive treadmill training in patients with acute ischemic stroke, (b) test whether physical activity of the legs during training increases with time, and (c) evaluate to what extent training sessions contribute toward the overall physical...

  14. Magnetic resonance imaging in acute ischemic stroke treatment.

    Science.gov (United States)

    Kim, Bum Joon; Kang, Hyun Goo; Kim, Hye-Jin; Ahn, Sung-Ho; Kim, Na Young; Warach, Steven; Kang, Dong-Wha

    2014-09-01

    Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. For example, the high sensitivity and specificity of diffusion-weighted image (DWI) can help distinguish acute ischemic stroke from stroke-mimics. Additionally, the lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent potential salvageable tissue by reperfusion therapy. However, the optimal threshold to discriminate between benign oligemic areas and the penumbra is still debatable. Signal changes of fluid-attenuated inversion recovery image within DWI lesions may be a surrogate marker for ischemic lesion age and might indicate risks of hemorrhage after thrombolysis. Clot sign on gradient echo image may reflect the nature of clot, and their location, length and morphology may provide predictive information on recanalization by reperfusion therapy. However, previous clinical trials which solely or mainly relied on perfusion-diffusion mismatch for patient selection, failed to show benefits of MRI-based thrombolysis. Therefore, understanding the clinical implication of various useful MRI findings and comprehensively incorporating those variables into therapeutic decision-making may be a more reasonable approach for expanding the indication of acute stroke thrombolysis. PMID:25328872

  15. Is adiponectin a risk factor for transient ischaemic attacks?

    Science.gov (United States)

    Sener, Ufuk; Uludag, Irem Fatma; Kose, Sukran; Ozcelik, Murat; Zorlu, Yasar

    2015-01-01

    Adiponectin is an adipocytokine, and it plays a role in atherosclerosis. The role of adiponectin in the development of ischaemic stroke is controversial. Up to now, adiponectin was not evaluated in transient ischaemic stroke. In this study, we investigated the relationship between adiponectin and transient ischaemic attack. Forty patients with transient ischaemic attack were included into the study. In all patients, traditional risk factors of ischaemic stroke and intima-media thickness of carotid arteries were determined. Also, the relationship between these parameters and adiponectin levels were examined. No difference was found in terms of adiponectin levels between patients and healthy subjects. In addition, there was no association between adiponectin levels and traditional risk factors. Our results suggest that adiponectin may not be a predictive risk factor of transient ischaemic attack.

  16. Prediction of acute stroke progression by the National Institutes of Health Stroke Scale

    Institute of Scientific and Technical Information of China (English)

    Vinh Phuong; Tran Van Huy

    2007-01-01

    Objective To determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to the initial stroke severity assessment. Methods The assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 68 consecutive ischemic stroke patients admitted to the Department of Geriatric Cardiology at the Khanh Hoa Hospital, Nha Trang, Vietnam. Incidence of stroke progression (a ≥ 3-point increase on the NIHSS) was recorded and analysis performed to determine its association with initial stroke severity and other demographic and physiological variables. Deficit resolution by 48 hours, defined as an NIHSS score of 0 or 1, measured the frequency of functional recovery predicted by the initial deficit.Results Overall progression was noted in 28% of events (19/68). Applying Bayes' solution to the observed frequency of worsening, the greatest likelihood of predicting future patient progression occurred with NIHSS score of =7 and >7. Patients with an initial NIHSS score of =7 experienced a 13% (6/47) worsening rate versus those of an initial score of>7 with a 62% (13/21) worsening rate (P<0.01). 42.5%(20/47) of those with an initial score of =7 were functionally normal at 48 hours, whereas only 4.7% (1/21) of those with scores of >7 retnrned to a normal examination within this period (x2, P<0.05). Conclusions This study suggests that the early clinical course of neurological deficit after acute stroke be dependent on the initial stroke severity and that a dichotomy in early outcome exist surrounding an initial NIHSS score of 7. These findings may have significant implications for the design and patient stratification in treatment protocols with respect to primary clinical outcome.

  17. Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

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    Ayan Sen

    2014-07-01

    Full Text Available Introduction: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods: This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA. Results: The mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83. Conclusion: This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring. [West J Emerg Med. 2014;15(4:–0.

  18. Factors delaying hospital arrival of patients with acute stroke

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    V V Ashraf

    2015-01-01

    Full Text Available Background: Low rates of thrombolysis for ischemic stroke in India and other developing countries have been attributed to delays in presentation to the hospital. Materials and Methods: A prospective study was carried out during a 12-month period ending December 2012 in the department of Neurology, Malabar Institute of Medical Sciences, Kerala, India, to look for the factors contributing to delay in hospital arrival of patients with acute stroke. Patients and or their relatives were interviewed within 48 hours of admission using a structured questionnaire. Results: A total of 264 patients attending the emergency department were included. There were 170 men and 94 women. The mean age was 61.5 ± 12.4 years. A total of 67 (25% patients presented within 4 hours of stroke onset. Factors associated with early arrival (multivariate logistic regression analysis were distance 15 km or less from hospital (P 0.03, odds ratio (OR 2.7, directly reaching the stroke department (P < 0.001, OR 9.7, history of coronary artery disease (P 0.001, OR 3.84, higher educational status (P 0.001, OR 3.7, and presence of hemiplegia (P 0.001, OR 5.5. Conclusions: We found a considerable delay in the early arrival of patients to our stroke department. Health promotion strategies to improve community awareness of early symptoms of stroke, education of local physicians about the importance of early referrals to the stroke centers, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital post stroke and thereby improve the management of stroke in India.

  19. Editor's choice - Safety of carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke

    DEFF Research Database (Denmark)

    Rathenborg, L K; Venermo, M; Troëng, T;

    2014-01-01

    OBJECTIVE: Few studies have been published on the safety of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT). Registry reports have been recommended in order to gather large study groups. DESIGN: A retrospective, registry based, case controlled study on prospectively gathered data...

  20. [Acute posterior multifocal placoid pigment epitheliopathy. A rare cause of ischaemic stroke].

    Science.gov (United States)

    del Saz-Saucedo, Pablo; Alfaya-Muñoz, Laura Blanca; Recio-Bermejo, Marta; Lara-Medina, Francisco Javier; García-Chiclano, Amalia; Ortega-León, Teresa; Rueda-Medina, Ignacio; Domínguez-Fernández, María José; Madrid-Muñiz, Carmen; Franco-Huerta, María

    2013-06-01

    Introduccion. La epiteliopatia pigmentaria placoide multifocal posterior aguda (EPPMPA) es una enfermedad inflamatoria rara, generalmente de etiologia indeterminada, de la coriocapilar, el epitelio pigmentario y la retina externa. Afecta predominantemente a pacientes jovenes y en algunos casos puede involucrar al sistema nervioso central en forma de ictus o de meningoencefalitis. Presentamos el caso clinico de una mujer joven con EPPMPA complicada con ictus e hipertension intracraneal. Caso clinico. Mujer de 16 anos que comienza con cefalea intensa sugestiva de hipertension intracraneal, asi como con un deficit agudo hemisferico izquierdo. La resonancia magnetica craneal ponia de manifiesto lesiones embolicas o vasculiticas en diferentes territorios. No se evidenciaron datos de meningoencefalitis en el estudio del liquido cefalorraquideo, pero si de hipertension intracraneal asociada. La presencia de lesiones muy especificas en el polo ocular posterior permitio el diagnostico de EPPMPA complicada con ictus isquemico, probablemente por mecanismo vasculitico. Un amplio estudio etiologico fue negativo para identificar un factor desencadenante claro del proceso. Se inicio tratamiento corticoideo con buena evolucion clinica y radiologica. Conclusiones. La EPPMPA es una entidad rara que generalmente entrana buen pronostico; sin embargo, en algunos casos puede complicarse con afectacion del sistema nervioso central, y el ictus isquemico secundario a vasculitis es la complicacion mas grave. Ante un paciente joven con ictus que presente sintomatologia visual y lesiones coriorretinianas, debe considerarse la EPPMPA en su diagnostico etiologico.

  1. The current concepts of computed tomography for acute stroke

    International Nuclear Information System (INIS)

    Stroke is one of a leading cause of death and disability worldwide. The major advances in stroke therapy in particular invasive therapy lead to application of new imaging techniques. The aim of this review is to present state-of-the-art concepts of computed tomography for acute stroke. The goals of a neuroimaging in acute stroke are to establish a diagnosis as early as possible and to evaluate brain perfusion and intracranial vessels' patency. State-of-the-art imaging in the era of multidetector computed tomography (CT) with high spatial and temporal resolution consists of multimodal CT imaging. Non enhanced CT is necessary for depiction of hemorrhage or early ischemic signs. CT angiography evaluates intravascular thrombi or significant stenosis, and CT perfusion demonstrates salvageable tissue at risk. By combining different imaging techniques in multimodal approach we can acquire information necessary for therapeutic planning and could select patients for thrombolysis. The imaging protocol should be tailored to the patient regarding to the time of onset, necessity and availability of CT modalities. (authors) Key words: Stroke. Computed Tomography (CT). Computed Tomography Angiography (CTA). Computed Tomography Perfusion (CTP)

  2. The effects of citicoline on acute ischemic stroke

    DEFF Research Database (Denmark)

    Overgaard, Karsten

    2014-01-01

    Early reopening of the occluded artery is, thus, important in ischemic stroke, and it has been calculated that 2 million neurons die every minute in an ischemic stroke if no effective therapy is given; therefore, "Time is Brain." In massive hemispheric infarction and edema, surgical decompression...... other neuroprotective agent had any beneficial effect in confirmative clinical trials or had any positive effect in the subgroup analysis. Citicoline is the only drug that in a number of different clinical stroke trials continuously had some neuroprotective benefit....... lowers the risk of death or severe disability defined as a modified Rankin Scale score greater than 4 in selected patients. The majority, around 80%-85% of all ischemic stroke victims, does not fulfill the criteria for revascularization therapy, and also for these patients, there is no effective acute...... therapy. Also there is no established effective acute treatment of spontaneous intracerebral bleeding. Therefore, an effective therapy applicable to all stroke victims is needed. The neuroprotective drug citicoline has been extensively studied in clinical trials with volunteers and more than 11...

  3. Evaluation of stroke services in Anglia stroke clinical network to examine the variation in acute services and stroke outcomes

    Directory of Open Access Journals (Sweden)

    George Abraham

    2011-02-01

    Full Text Available Abstract Background Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. Methods/Design We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy completed EuroQol (EQ-5D questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. Discussion This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.

  4. Acute MRI Changes in Progressive Ischemic Stroke

    DEFF Research Database (Denmark)

    Kalowska, Elizabeth; Rostrup, Egill; Rosenbaum, S;

    2008-01-01

    as a permanent decrease of >/=3 Scandinavian Stroke Scale (SSS) points for speech or >/=2 SSS points for consciousness or >/=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using...... (chi(2), p = 0.005). All lacunar infarcts with a DWI volume >1.5 cm(3) at baseline (4 patients) developed SIP (p lower baseline SSS scores with severer symptoms than non-SIP patients (p Udgivelsesdato: 2008-Feb-8...

  5. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.;

    2008-01-01

    as a permanent decrease of >or=3 Scandinavian Stroke Scale (SSS) points for speech or >or=2 SSS points for consciousness or >or=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using...... (chi(2), p = 0.005). All lacunar infarcts with a DWI volume >1.5 cm(3) at baseline (4 patients) developed SIP (p lower baseline SSS scores with severer symptoms than non-SIP patients (p Udgivelsesdato: 2008...

  6. Sex Differences in Stroke Subtypes, Severity, Risk Factors, and Outcomes Among Elderly Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Changshen eYu

    2015-09-01

    Full Text Available Background: Although the age-specific incidence and mortality of stroke is higher among men, stroke has a greater clinical effect on women. However, the sex differences in stroke among elderly patients are unknown. Therefore, we aimed to assess the sex differences in stroke among elderly stroke patients.Methods: Between 2005 and 2013, we recruited 1,484 consecutive acute ischemic stroke patients (≥75 years old from a specialized neurology hospital in Tianjin, China. Information regarding their stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were recorded.Results: Comparing with men, women had a significantly higher prevalence of severe stroke (17.20% vs. 12.54%, hypertension (76.42% vs. 66.39%, dyslipidemias (30.35% vs. 22.76%, and obesity (18.40% vs. 9.32%, P < 0.05. Comparing with women, men had a significantly higher prevalence of intracranial artery stenosis (23.11% vs. 17.45%, current smoking (29.60% vs. 13.05%, and alcohol consumption (12.15% vs. 0.47%, P < 0.05. Moreover, dependency was more common among women at 3 and 12 months after stroke, although the sex difference disappeared after adjusting for stroke subtypes, severity, and risk factors. Conclusions: Elderly women with acute ischemic stroke had more severe stroke status and worse outcomes at 3 and 12 months after stroke. Thus, elderly female post-acute ischemic stroke patients are a crucial population that should be assisted with controlling their risk factors for stroke and changing their lifestyle.

  7. Lack of association between serum uric acid levels and outcome in acute ischemic stroke

    NARCIS (Netherlands)

    Miedema, Irene; Uyttenboogaart, Maarten; Koch, Marcus; Kremer, Berry; de Keyser, Jacques; Luijckx, Gert-Jan

    2012-01-01

    Background: The prognostic value of serum uric acid (UA) in acute ischemic stroke is controversial. The aim of this study is to further analyse the relation between UA and outcome after acute ischemic stroke. Methods: We analysed UA levels in blood samples collected within 6 h of stroke onset from p

  8. Off-Hours Admission and Acute Stroke Care Quality

    DEFF Research Database (Denmark)

    Kristiansen, Nina Sahlertz; Mainz, Jan; Nørgård, Bente Mertz;

    2014-01-01

    stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. Methods-A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64...... of care. However, the admission time-related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity....... 975). Off-hours were weekends and evening and nighttime shifts on weekdays. Compliance with performance measures was compared using general linear modeling, and odds ratios for 30 days case-fatality were obtained using multivariable logistic regression. Results-Patients admitted off-hours had a lower...

  9. Drug repurposing for immune modulation in acute ischemic stroke.

    Science.gov (United States)

    Amantea, Diana; Bagetta, Giacinto

    2016-02-01

    Innate immune cells play a dualistic role in the evolution of ischemic brain damage, with classic phenotypes promoting injury, and alternatively activated M2 microglia/macrophages or N2 neutrophils providing tissue remodelling and repair. Recently, a number of drugs commonly used for other indications (i.e., azithromycin, minocycline, bexarotene, rosiglitazone, metformin) was reported to provide neuroprotection in preclinical stroke models by promoting immune polarization towards non-inflammatory, protective phenotypes. Repurposing drugs with a well-established safety profile should allow a reduction in the risk of clinical trial failure that has dominated the unsuccessful development of neuroprotective drugs in stroke during the last decades. The clinical validation of the proof of concept, followed by the assessment of safety and efficacy of immune-polarizing repurposed drugs will definitively offer new opportunities for the acute treatment of ischemic stroke. PMID:26657075

  10. [Endarterectomy more favourable than stenting in symptomatic significant carotid stenosis: higher risk of ischaemic stroke or death following stenting].

    Science.gov (United States)

    Meerwaldt, Robbert; Beuk, Roland J; Huisman, Ad B; Manschot, Sanne M; Zeebregts, Clark J; Geelkerken, Robert H

    2011-01-01

    Carotid endarterectomy (CEA) has proven its value in the treatment of patients with recent significant carotid artery stenosis. Percutaneous transluminal angioplasty with carotid artery stenting ('stenting' in short) is an alternative to CEA. The results of stenting and CEA in patients with symptomatic significant carotid artery stenosis were evaluated in 9 prospective randomized controlled trials and 11 meta-analyses. Almost all of these trials failed to show superiority of stenting to CEA. According to the 4 largest and most recent studies in this field the risk of a stroke or death within 30 days after the intervention is considerably higher following stenting than following CEA. In the long run the results of stenting and CEA seem to be comparable. CEA remains the gold standard in treatment of significant carotid artery stenosis, in particular in patients older than 70.

  11. Basics of acute stroke treatment; Grundzuege der akuten Schlaganfalltherapie

    Energy Technology Data Exchange (ETDEWEB)

    Haass, A. [Neurologische Universitaetsklinik Homburg/Saar (Germany)

    2005-05-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O{sub 2} delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [German] Jeder akute Schlaganfall ist ein Notfall und muss sofort in einer spezialisierten Klinik, am besten einer Stroke Unit, behandelt werden. Die Stroke-Unit-Behandlung senkt den Behinderungsgrad und die Letalitaet um 30% staerker als die

  12. [Current registry studies of acute ischemic stroke].

    Science.gov (United States)

    Veltkamp, R; Jüttler, E; Pfefferkorn, T; Purrucker, J; Ringleb, P

    2012-10-01

    Study registries offer the opportunity to evaluate the effects of new therapies or to observe the consequences of new treatments in clinical practice. The SITS-MOST registry confirmed the validity of findings from randomized trials on intravenous thrombolysis concerning safety and efficacy in the clinical routine. Current study registries concerning new interventional thrombectomy techniques suggest a high recanalization rate; however, the clinical benefit can only be evaluated in randomized, controlled trials. Similarly, the experiences of the BASICS registry on basilar artery occlusion have led to the initiation of a controlled trial. The benefit of hemicraniectomy in malignant middle cerebral artery infarction has been demonstrated by the pooled analysis of three randomized trials. Numerous relevant aspects are currently documented in the DESTINY-R registry. Finally, the recently started RASUNOA registry examines diagnostic and therapeutic aspects of ischemic and hemorrhagic stroke occurring during therapy with new oral anticoagulants.

  13. Early warning score predicts acute mortality in stroke patients

    DEFF Research Database (Denmark)

    Liljehult, J; Christensen, T

    2016-01-01

    was to investigate whether the aggregate weighted track and trigger system early warning score (EWS) can be used as a simple observational tool to identify patients at risk and predict mortality in a population of patients with acute stroke. MATERIALS AND METHODS: Patients admitted with acute stroke...... at the Copenhagen University Hospital, Nordsjaellands Hospital, Denmark, from May to September 2012 were enrolled in a retrospective cohort study (n = 274). Vital signs were measured immediately after admission and consistently during the hospitalization period. Based on the vital signs, a single composite EWS...... the EWS at admission (AUROC 0.856; 95% CI 0.760-0.951; P-value score is a simple and valid...

  14. Hyperglycemia in nondiabetic patients during the acute phase of stroke

    Directory of Open Access Journals (Sweden)

    Daniel Agustin Godoy

    2012-02-01

    Full Text Available OBJECTIVE: To determine patterns of hyperglycemic (HG control in acute stroke. METHODS: Anonymous survey through Internet questionnaire. Participants included Latin-American physicians specialized in neurocritical care. RESULTS: The response rate was 74%. HG definition varied widely. Fifty per cent considered it when values were >140 mg/dL (7.8 mmol/L. Intravenous (IV regular insulin was the drug of choice for HG correction. One fifth of the respondents expressed adherence to a protocol. Intensive insulin therapy (IIT was used by 23%. Glucose levels were measured in all participants at admission. Routine laboratory test was the preferred method for monitoring. Reactive strips were more frequently used when monitoring was intensive. Most practitioners (56.7% monitored glucose more than two times daily throughout the Intensive Care Unit stay. CONCLUSIONS: There is considerable variability and heterogeneity in the management of elevated blood glucose during acute phase of stroke by the surveyed Latin-American physicians.

  15. Diffusion-weighted MRI in acute cerebral stroke

    Energy Technology Data Exchange (ETDEWEB)

    Takayama, Hideichi; Kobayashi, Masahito; Suga, Sadao; Kawase, Takeshi; Nagasawa, Masakazu; Sadanaga, Humiko; Okamura, Miyuki; Kanai, Yoshihiro; Mihara, Ban [Mihara Memorial Hospital, Isezaki, Gunma (Japan)

    1999-03-01

    Diffusion-weighted MRI has been demonstrated to be valuable in the assessment of cerebral stroke. Recent advance in MR systems of hardware with larger maximum gradient amplitude and faster imaging strategies, such as EPI, has made it possible to acquire whole brain diffusion-weighted imaging (DWI) in less that one minute. The purposes of this study are to evaluate clinical usefulness of DWI and to clarify pitfalls in the diagnosis of acute cerebral stroke. Seventeen patients with 18 ischemic lesions were studied. DWI were taken with 1.5 Tesla MRI (Magnetom Vision, Siemens, Germany) using EPI sequence. Fifteen lesions out of them (3 in cerebral cortex, 9 in basal ganglia/deep white matter and 3 in cerebellum) were studied serially at various times up to 147 days. Acute cerebral infarction was seen clearly as an area of hyperintensity with DWI and as hypointensity in apparent diffusion coefficient (ADC) maps which are indicative of decreased diffusion. DWI detected areas of hyperintense acute infarcts, as early as 2.5 hours after onset, which were not visualized on T{sub 2}-weighted image (T2WI). The lesion of cerebral infarction became isointense in ADC maps at 14-28 days after onset, whereas with DWI it became isointense at about 2 months. Because ADC changed earlier than DWI, ADC maps were useful for differentiate acute from nonacute lesion in cases of recurrent stroke within a short period. In a patient with transient global amnesia for 7 hours, DWI did not show any lesion at 8 hours. In terms of cerebral hemorrhage, lesions were seen as area of hyperintensity in DWI at 3 days and were not distinguishable from that of infarct. Despite limitations in the diagnosis of transient ischemia and cerebral hemorrhage, DWI is a useful technique for early detection of cerebral infarction, especially within the first 6 hours after stroke onset. (author)

  16. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review.

    Science.gov (United States)

    Lambrinos, Anna; Schaink, Alexis K; Dhalla, Irfan; Krings, Timo; Casaubon, Leanne K; Sikich, Nancy; Lum, Cheemun; Bharatha, Aditya; Pereira, Vitor Mendes; Stotts, Grant; Saposnik, Gustavo; Kelloway, Linda; Xie, Xuanqian; Hill, Michael D

    2016-07-01

    Although intravenous thrombolysis increases the probability of a good functional outcome in carefully selected patients with acute ischemic stroke, a substantial proportion of patients who receive thrombolysis do not have a good outcome. Several recent trials of mechanical thrombectomy appear to indicate that this treatment may be superior to thrombolysis. We therefore conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of new-generation mechanical thrombectomy devices with intravenous thrombolysis (if eligible) compared with intravenous thrombolysis (if eligible) in patients with acute ischemic stroke caused by a proximal intracranial occlusion. We systematically searched seven databases for randomized controlled trials published between January 2005 and March 2015 comparing stent retrievers or thromboaspiration devices with best medical therapy (with or without intravenous thrombolysis) in adults with acute ischemic stroke. We assessed risk of bias and overall quality of the included trials. We combined the data using a fixed or random effects meta-analysis, where appropriate. We identified 1579 studies; of these, we evaluated 122 full-text papers and included five randomized control trials (n=1287). Compared with patients treated medically, patients who received mechanical thrombectomy were more likely to be functionally independent as measured by a modified Rankin score of 0-2 (odds ratio, 2.39; 95% confidence interval, 1.88-3.04; I2=0%). This finding was robust to subgroup analysis. Mortality and symptomatic intracerebral hemorrhage were not significantly different between the two groups. Mechanical thrombectomy significantly improves functional independence in appropriately selected patients with acute ischemic stroke. PMID:27071728

  17. Post-stroke apathy and hypersomnia lead to worse outcomes from acute rehabilitation

    OpenAIRE

    Harris, Ari L.; Elder, Jessica; Schiff, Nicholas D.; Victor, Jonathan D.; Goldfine, Andrew M.

    2013-01-01

    Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. ...

  18. High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined {sup 18}F-FDG PET/MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hyafil, Fabien [Technische Universitaet Muenchen, Department of Nuclear Medicine, Klinikum rechts der Isar, Munich (Germany); Bichat University Hospital, Department of Nuclear Medicine, Paris (France); Schindler, Andreas; Obenhuber, Tilman; Saam, Tobias [Ludwig Maximilians University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Sepp, Dominik; Hoehn, Sabine; Poppert, Holger [Technische Universitaet Muenchen, Department of Neurology, Klinikum rechts der Isar, Munich (Germany); Bayer-Karpinska, Anna [Ludwig Maximilians University Hospital Munich, Institute for Stroke and Dementia Research, Munich (Germany); Boeckh-Behrens, Tobias [Technische Universitaet Muenchen, Department of Neuroradiology, Klinikum Rechts der Isar, Munich (Germany); Hacker, Marcus [Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Nekolla, Stephan G. [Technische Universitaet Muenchen, Department of Nuclear Medicine, Klinikum rechts der Isar, Munich (Germany); Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich (Germany); Rominger, Axel [Ludwig Maximilians University Hospital Munich, Department of Nuclear Medicine, Munich (Germany); Dichgans, Martin [Technische Universitaet Muenchen, Department of Neurology, Klinikum rechts der Isar, Munich (Germany); Munich Cluster of Systems Neurology (SyNergy), Munich (Germany); Schwaiger, Markus [Technische Universitaet Muenchen, Department of Nuclear Medicine, Klinikum rechts der Isar, Munich (Germany)

    2016-02-15

    The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and {sup 18}F-fluoro-deoxyglucose positron emission tomography ({sup 18}F-FDG PET) imaging. Carotid arteries were imaged 150 min after injection of {sup 18}F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. {sup 18}F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections. The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher {sup 18}F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher {sup 18}F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques. Morphological and biological features of high-risk plaques can be detected with {sup 18}F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral

  19. Serum cardiac troponin I in acute stroke is related to serum cortisol and TNF-alpha

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Johannesen, Helle Hjorth; Christensen, Anders Fogh;

    2004-01-01

    Serum cardiac troponin I (cTnI) is a specific marker of myocardial injury related to in-patient fatality and cardiac injury in acute stroke. We investigated whether cTnI in acute stroke is related to serum cortisol, acute inflammatory response, and insular damage. We also investigated whether c...

  20. Hypothermia for Stroke: call to action 2010

    DEFF Research Database (Denmark)

    Macleod, Malcolm R; Petersson, Jesper; Norrving, Bo;

    2010-01-01

    , there is a need for an efficacious, cost-effective novel therapy that can be implemented broadly within European health care systems. Accordingly, the primary objective of the workshop was the definition of a research agenda aiming to assess the therapeutic benefits of hypothermia in patients with acute ischaemic...... Agency, and small- and medium-sized enterprises based in EU member states. The participants adopted the 'Hypothermia for Stroke--Call to Action 2010', a declaration specifying the priorities for hypothermia research in acute ischaemic stroke. The research programme outlined--a clinical study programme...... designed to identify and validate therapeutic cooling as a novel treatment providing benefit to a large number of stroke patients--contains a well-integrated series of Phase II studies aiming to refine the intervention (depth, duration, and mode of cooling; antishivering strategy; patient selection...

  1. [Cadasil and other hereditary small vessel diseases of the brain--increasingly diagnosed conditions underlying familial ischaemic stroke and dementia].

    Science.gov (United States)

    Gunda, Bence; Chabriat, Hugues; Bereczki, Dániel

    2011-03-30

    CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) has recently gained great interest in vascular neurology as the most common heritable cause of stroke and vascular dementia in adults. This autosomal dominant small vessel disease of the brain--unlike the sporadic, hypertensive form--appears already in adult midlife in the absence of vascular risk factors with ischemic episodes and progressive dementia, its first manifestation can be migraine with aura, and is often associated with psychiatric disturbances. The magnetic resonance imaging (MRI) changes showing a characteristic pattern may precede symptoms by more than a decade. The identification of the mutation of the NOTCH 3 gene responsible for the disorder encoding a transmembrane receptor of vascular smooth muscle cells - has given great impetus on research to understand the molecular and vascular pathogenesis of the disease. The special importance of this latter lies in the fact that CADASIL provides a pure genetic model for subcortical cerebral ischemia and vascular dementia without the confounding factors of comorbidities and advanced age. Thus insights into CADASIL may help us better understand the more common sporadic forms as well. Moreover CADASIL is one of the best studied examples of secondary migraine. Currently we have far less knowledge on other forms of hereditary small vessel disease of the brain such as CARASIL, HERNS, CRV, HVR, PXE etc. Neurologists are becoming more and more familiar with CADASIL, and with the wider availability of MRI it is increasingly diagnosed. However the disorder is still probably underrecognised. This review aims to summarize our current knowledge on CADASIL with special emphasis on diagnostic and differential diagnostic points for the practising neurologist. PMID:21545006

  2. Specific antismoking advice after stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete; Larsen, Klaus; Brink-Kjær, Tove;

    2014-01-01

    -smokers in the intervention group than among controls. MATERIAL AND METHODS: Patients admitted with an acute stroke or a transient ischaemic attack were included in a randomised controlled trial focusing on control of lifestyle risk factors and hypertension. Here, we report the intervention focused on smoking cessation. We...... Elsass Foundation, the Lundbeck Foundation and The Danish Heart Foundation (Grant 07-4-B703-A1378-22384F). TRIAL REGISTRATION: This protocol is registered with Clinical Trials.gov (NCT 00253097)....

  3. Current trends in the management of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Srinivasan Paramasivam

    2015-01-01

    Full Text Available Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS. Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly

  4. Current trends in the management of acute ischemic stroke.

    Science.gov (United States)

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  5. NIHSS and acute complications after anterior and posterior circulation strokes

    Directory of Open Access Journals (Sweden)

    Godefroy O

    2012-02-01

    Full Text Available Mathieu Boone1, Jean-Marc Chillon2, Pierre-Yves Garcia1, Sandrine Canaple1, Chantal Lamy1, Olivier Godefroy1,3, Jean-Marc Bugnicourt1,2,31Department of Neurology, Amiens University Hospital, Amiens, France, 2INSERM ERI-12, and University of Picardie, 3Laboratory of Functional Neurosciences and Pathology (EA 4559, Amiens, FranceBackground: The purpose of this study was to determine whether the National Institutes of Health Stroke Scale (NIHSS score was associated with inhospital neurological and medical complications (NMC in patients with posterior circulation infarction.Methods: This retrospective study included all patients admitted to our stroke unit during a one-year period (n = 289. NMC included neurological deterioration (ie, worsening by 4 points or more of the NIHSS score during the hospital stay and all other medical complications based on what was recorded in the patients' charts.Results: Seventy-nine patients (27% experienced NMC. In posterior circulation infarction patients (n = 90, patients with NMC had a higher baseline NIHSS score (10.9 versus 2.2, P = 0.004 and a baseline NIHSS score >2 (78% versus 36%, P = 0.003. In stepwise logistic regression, an NIHSS score >2 (odds ratio: 8.2; 95% confidence interval: 1.64–41.0; P = 0.01 was associated with NMC. Similar results were observed for anterior circulation infarction patients but with a higher cutoff value for NIHSS score.Conclusion: In ischemic stroke patients, an increased baseline NIHSS score was associated with an increased risk of NMC. This association applied to anterior-circulation as well as posterior circulation stroke, although zero on the NIHSS for posterior circulation stroke does not mean the absence of NMC during hospitalization. The clinical significance of these findings requires further evaluation in larger prospective studies.Keywords: acute, stroke, rating scales, complications

  6. The economics of treating stroke as an acute brain attack.

    Science.gov (United States)

    Bogousslavsky, Julien; Paciaroni, Maurizio

    2009-01-01

    Currently, treatments for ischemic stroke focus on restoring or improving perfusion to the ischemic area using thrombolytics. The increased hospitalization costs related to thrombolysis are offset by a decrease in rehabilitation costs, for a net cost savings to the healthcare system. However, early treatment is essential. The benefit of thrombolysis is time-dependent but only a very small proportion of patients, 2%, are presently being treated with tPA. In the United States, if the proportion of all ischemic stroke patients that receive tPA were increased to 4, 6, 8, 10, 15, or 20%, the realized cost saving would be approximately $ 15, 22, 30, 37, 55, and 74 million, respectively. Being so, efforts should be made to educate the public and paramedics regarding early stroke signs. Furthermore, additional acute stroke therapy training programs need to be established for emergency departments. Finally, hospital systems need to be re-engineered to treat patients as quickly as possible in order to optimize thrombolytic benefit as well as maximize cost-effectiveness. PMID:19775424

  7. S-100AND#946; protein as a biomarker in acute hemorrhagic stroke

    Directory of Open Access Journals (Sweden)

    Omkar Prasad Baidya

    2014-02-01

    Full Text Available Acute hemorrhagic stroke, a subtype of acute stroke is one of the leading causes of death and disability throughout the world. At present, the diagnosis of acute hemorrhagic stroke is mainly based on Computer Tomography (CT or Magnetic Resonance Imaging (MRI but till now no biomarkers are routinely used in acute hemorrhagic stroke management. This article is a critical and descriptive review on the role of S100β protein as a biomarker in acute hemorrhagic stroke. Plasma S-100β level increases significantly in acute hemorrhagic stroke patients when compared to the normal subjects. Beside, the plasma S-100β can be correlated to the volume of hemorrhage in brain measured by plane CT scan. Plasma S-100β is an useful biomarker in acute hemorrhagic stroke and can be used for estimation of volume of hemorrhage in brain in acute hemorrhagic stroke patients. Thus, S-100β can be useful as an alternative to CT scan/MRI in diagnosis and in taking therapeutic decision in acute hemorrhagic stroke management. [Int J Res Med Sci 2014; 2(1.000: 13-15

  8. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

    Directory of Open Access Journals (Sweden)

    Nikolay Dimitrov

    2015-10-01

    Full Text Available Introduction: Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods: Each county’s local emergency medical services agency (LEMSA was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results: Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45% had stroke routing protocols, covering 23 counties (40% and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile. In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion: California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  9. Reducing Haemorrhagic Transformation after Thrombolysis for Stroke: A Strategy Utilising Minocycline

    Directory of Open Access Journals (Sweden)

    David J. Blacker

    2013-01-01

    Full Text Available Haemorrhagic transformation (HT of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs. The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA. The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS aims to determine the safety and efficacy of adding minocycline to tPA in acute ischaemic stroke. The WAIMATSS is a multicentre, prospective, and randomised pilot study of intravenous minocycline, 200 mg 12 hourly for 5 doses, compared with standard care, in patients with ischaemic stroke treated with intravenous tPA. The primary endpoint is HT diagnosed by brain CT and MRI. Secondary endpoints include clinical outcome measures. Some illustrative cases from the early recruitment phase of this study will be presented, and future perspectives will be discussed.

  10. Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke : a systematic review

    NARCIS (Netherlands)

    Nijland, Rinske; Kwakkel, Gert; Bakers, Japie; van Wegen, Erwin

    2011-01-01

    Constraint-induced movement therapy is a commonly used intervention to improve upper limb function after stroke. However, the effectiveness of constraint-induced movement therapy and its optimal dosage during acute or sub-acute stroke is still under debate. To examine the literature on the effects o

  11. A Research on Factors Influencing the Clinical Prognosis of Acute Stroke Patie.patients

    Institute of Scientific and Technical Information of China (English)

    Luo Zuming; Li Manli

    2000-01-01

    Object: To search for the factors significantly influencing the clinical prognosis of acute stroke patients. Background: There are lack of prospective multivariate analysis research m acute stroke in the world. Method: We chose 17 factors possibly influencing the prognosis of acute patients, took Barthel′s Index at the end of 2 months after stroke onset and decreased percentage of neurological deficit scores (MESSS) between 72h after hospitalization and 2 months after onset as gold standard, to have a prospective, multivariate analysis research combined with univariate analysis. Results: Multivariate analysis of 106 acute stroke patients combined with univariate analysis showed the factors significantly influencing the clinical prognosis of acute stroke patients were: initial MESSS score、 age、 complication、 mass effect、 stroke location、 time of delay before emergency arrival (BDT). Time of delay after emergency arrival was not found to be a significant prognostic factor. Discussion: Barthel Index at the end of 1 month after stroke onset was strongly related to that at the end of 2 month after onset, as was the same with MESSS score. It showed there was no significant difference between 1 month and 2 months after stroke onset when we choose time interval in evaluating prognosis of acute stroke patients.Conclusion: BDT、 initial MESSS score、 age、 stroke location、 mass effect、 complication were important factors of acute stroke patients. Avoid the delay before emergency arrival after onset, prevent and treat complications after stroke, more carefully treat acute stroke patients with advanced age, advanced age, high initial MESSS scores and those with mass effect reported by CT, we can improve the outcome of stroke patients.

  12. Acute cerebral paragonimiasis presenting as hemorrhagic stroke in a child.

    Science.gov (United States)

    Chen, Zhi; Zhu, Gang; Lin, Jiangkai; Wu, Nan; Feng, Hua

    2008-08-01

    A hemorrhagic stroke in children is rarely secondary to cerebral paragonimiasis. We describe a 9-year-old boy in whom an intracerebral hemorrhage was the leading clinical indication of acute cerebral paragonimiasis. He was hospitalized because of a sudden onset of headache, right hemiparesis, and dysarthria. A computed tomography scan revealed an intracerebral hemorrhage in the left parietal lobe. Magnetic resonance angiography did not confirm any vascular abnormalities at the location of the hematoma. Four weeks later, he presented with right hemiparesis again, and fever. A diagnosis of cerebral paragonimiasis was based on repeated magnetic resonance imaging of the brain and an enzyme-linked immunosorbent assay for paragonimiasis. The patient gradually recovered with praziquantel treatment. Cerebral paragonimiasis should be considered in the differential diagnosis of hemorrhagic strokes in children in areas where paragonimiasis is epidemic.

  13. Timing of blood pressure lowering in acute ischemic stroke.

    Science.gov (United States)

    Carcel, Cheryl; Anderson, Craig S

    2015-08-01

    Whether there are any benefits without harm from early lowering of blood pressure (BP) in the setting of acute ischemic stroke (AIS) has been a longstanding controversy in medicine. Whilst most studies have consistently shown associations between elevated BP, particularly systolic BP, and poor outcome, some also report that very low BP (systolic <130 mmHg) and large reductions in systolic BP are associated with poor outcomes in AIS. However, despite these associations, the observed U- or J-shaped relationship between BP and outcome in these patients may not be causally related. Patients with more severe strokes may have a more prominent autonomic response and later lower BP as their condition worsens, often pre-terminally. Fortunately, substantial progress has been made in recent years with new evidence arising from well-conducted randomized trials. This review outlines new evidence and recommendations for clinical practice over BP management in AIS. PMID:26041479

  14. Prognostic value of copeptin in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Chen Hui

    2011-08-01

    Full Text Available Stroke is the second leading cause of mortality in the Chinaand one of the leading causes of severe morbidity. An earlyrisk assessment with estimate of the severity of disease andprognosis is pivotal for optimized care and allocation ofhealthcare resources. Reliable prognostic markers availableduring the initial phase after acute stroke may aid clinicaldecision-making.Vasopressin (AVP is a potent synergistic factor ofcorticotropin-releasing hormone as hypothalamic stimulator ofthe hypothalamo-pituitary-adrenal axis.1 Some studies foundincreased AVP levels in patients with ischemic stroke werecorrelated with stroke severity2 and outcome.3 Copeptin isreleased in an equimolar ratio to AVP, and is more stable inthe circulation and easy to measure.4We designed a preliminary prospective cohort study toevaluate the prognostic value of copeptin in acute strokepatients. Adult patients with a persistent neurological deficitdue to ischemic stroke were eligible. Sixty-ninenonconsecutive patients admitted at 3 hospitals with adiagnosis of acute ischemic stroke confirmed by CT scanningwere evaluated. All patients provided informed consent. Inpatients who died within 24 hours after admission or inpatients who were discharged, data from admission or untildischarge were collected. The National Institute of HealthStroke Scale (NIHSS score was assessed on admission.Functional outcome was obtained on days 90 according to themodified Rankin Scale (mRS blinded to copeptin levels. Poorfunctional outcome at 3 months was considered as a mRSscore > 2. Blood samples were collected on admission andimmediately centrifuged and sera stored at –70°C. Copeptinwas measured with a sandwich immunoluminometricassay.1 Discrete variables are summarized as counts(percentage, and continuous variables as medians andinterquartile ranges (IQRs. Two-group comparison of notnormally distributed data was performed using Mann–Whitney U test, and a Kruskal–Wallis one-way analysis

  15. Patterns of Reading Performance in Acute Stroke: A Descriptive Analysis

    Directory of Open Access Journals (Sweden)

    Lauren L. Cloutman

    2010-01-01

    Full Text Available One of the main sources of information regarding the underlying processes involved in both normal and impaired reading has been the study of reading deficits that occur as a result of brain damage. However, patterns of reading deficits found acutely after brain injury have been little explored. The observed patterns of performance in chronic stroke patients might reflect reorganization of the cognitive processes underlying reading or development of compensatory strategies that are not normally used to read. Method: 112 acute left hemisphere stroke patients were administered a task of oral reading of words and pseudowords within 1–2 days of hospital admission; performance was examined for error rate and type, and compared to that on tasks involving visual lexical decision, visual/auditory comprehension, and naming. Results: Several distinct patterns of performance were identified. Although similarities were found between the patterns of reading performance observed acutely and the classical acquired dyslexias generally identified more chronically, some notable differences were observed. Of interest was the finding that no patient produced any pure semantic errors in reading, despite finding such errors in comprehension and naming.

  16. [Telemedicine in acute stroke care--a health economics view].

    Science.gov (United States)

    Günzel, F; Theiss, S; Knüppel, P; Halberstadt, S; Rose, G; Raith, M

    2010-05-01

    Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

  17. Discharge home after acute stroke : Differences between older and younger patients

    NARCIS (Netherlands)

    Dutrieux, Roy D.; Van Eijk, Monica; Van Mierlo, Marloes L.; Van Heugten, Caroline M.; Visser-Meily, Johanna M A; Achterberg, Wilco P.

    2016-01-01

    Objective: To identify determinants for discharge destination of older (≥ 70 years) and younger (<70 years) acute stroke patients. Design: Multicentre prospective cohort. Patients: A total of 395 patients, within 7 days of clinically evaluated stroke, were included from 6 hospital stroke units. Meth

  18. Management of acute stroke in patients taking novel oral anticoagulants

    OpenAIRE

    Hankey, Graeme J; Norrving, Bo; Hacke, Werner; Steiner, Thorsten

    2014-01-01

    Each year, 1·0–2·0% of individuals with atrial fibrillation and 0·1–0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2–0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offer...

  19. Effects of melatonin in experimental stroke models in acute, sub-acute, and chronic stages

    Directory of Open Access Journals (Sweden)

    Hsiao-Wen Lin

    2009-03-01

    Full Text Available Hsiao-Wen Lin, E-Jian LeeNeurophysiology Laboratory, Neurosurgical Service, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, TaiwanAbstract: Melatonin (N-acetyl-5-methoxy-tryptamine, a naturally occurring indole produced mainly by the pineal gland, is a well known antioxidant. Stroke (cerebral ischemia is the second leading cause of death worldwide. To date, however, effective and safe treatment for stroke remains unavailable. Melatonin is both lipid- and water-soluble and readily crosses the blood–brain barrier (BBB. Increasing evidence has shown that, in animal stroke models, administering melatonin significantly reduces infarct volume, edema, and oxidative damage and improves electrophysiological and behavioral performance. Here, we reviewed studies that assess effects of melatonin on cerebral ischemia in acute, sub-acute, and chronic stages. In addition to its potent antioxidant properties, melatonin exerts antiapoptotic, antiexcitotoxic, anti-inflammatory effects and promotes mitochondrial functions in animals with cerebral ischemia. Given that melatonin shows almost no toxicity to humans and possesses multifaceted protective capacity against cerebral ischemia, it is valuable to consider using melatonin in clinical trials on patients suffering from stroke.Keywords: cerebral ischemia, melatonin, stroke, neuroprotection

  20. Detection of acute cerebral ischaemia with Tc-99m apcitide scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Tepmongkol, S. [Nuclear Medicine Division, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330 (Thailand)

    2002-10-01

    The established indication for Tc99m apcitide scintigraphy is for detecting deep venous thrombosis. However, due to its mechanism of binding to GP IIb/IIIa receptors on activated platelets, it can be used to image acute cerebral thrombosis. I report a patient with an acute ischaemic stroke, with right leg swelling, referred for Tc99m apcitide scintigraphy to show of deep venous thrombosis. There was no abnormal uptake in the legs but there was in the left parieto-occipital region. This correlated with the clinical and CT data, indicating an acute ischaemic stroke in this area. (orig.)

  1. Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system.

    Science.gov (United States)

    Aaron, Sanjith; Shyamkumar, N K; Alexander, Sunithi; Babu, P Suresh; Prabhakar, A T; Moses, Vinu; Murthy, T V; Alexander, Mathew

    2016-01-01

    Even though intravenous thrombolysis with tissue plasminogen activator (IV tPA) is the standard of care in acute ischemic stroke, its use in pregnancy is not clearly defined. Mechanical thrombectomy devices can be an option; however, literature on the use of such mechanical devices in stroke in pregnancy is lacking. Here we describe two cases that developed acute embolic stroke during pregnancy who were successfully treated by mechanical clot retrieval using the Penumbra system 28 (Penumbra Inc., Alameda, California, USA). To the best of our knowledge, these are the only case reports on the use of the Penumbra device in pregnant patients with acute ischemic stroke. PMID:27293343

  2. Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial

    NARCIS (Netherlands)

    D.W.J. Dippel (Diederik); E.J. van Breda (Eric); H.M.A. van Gemert (Maarten); H.B. van der Worp (Bart); R.J. Meijer (Ron); L.J. Kappelle (Jaap); P.J. Koudstaal (Peter Jan)

    2001-01-01

    textabstractBACKGROUND AND PURPOSE: Body temperature is a strong predictor of outcome in acute stroke. However, it is unknown whether antipyretic treatment leads to early and clinically worthwhile reduction of body temperature in patients with acute stroke, especially w

  3. Manual and oral apraxia in acute stroke, frequency and influence on functional outcome

    DEFF Research Database (Denmark)

    Pedersen, P M; Jørgensen, H S; Kammersgaard, L P;

    2001-01-01

    To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome.......To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome....

  4. Selected acute phase CSF factors in ischemic stroke: findings and prognostic value

    OpenAIRE

    Intskirveli Nino; Shakarishvili1 Roman; Sanikidze Tamar; Beridze Maia; Bornstein Natan M

    2011-01-01

    Abstract Background Study aimed at investigation of pathogenic role and prognostic value of several selected cerebrospinal fluid acute phase factors that can reflect the severity of ischemic brain damage. Methods Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Ind...

  5. Modelling the Role of Dietary Habits and Eating Behaviours on the Development of Acute Coronary Syndrome or Stroke: Aims, Design, and Validation Properties of a Case-Control Study

    Directory of Open Access Journals (Sweden)

    Christina-Maria Kastorini

    2011-01-01

    Full Text Available In this paper the methodology and procedures of a case-control study that will be developed for assessing the role of dietary habits and eating behaviours on the development of acute coronary syndrome and stroke is presented. Based on statistical power calculations, 1000 participants will be enrolled; of them, 250 will be consecutive patients with a first acute coronary event, 250 consecutive patients with a first ischaemic stroke, and 500 population-based healthy subjects (controls, age and sex matched to the cases. Socio-demographic, clinical, dietary, psychological, and other lifestyle characteristics will be measured. Dietary habits and eating behaviours will be evaluated with a special questionnaire that has been developed for the study.

  6. Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

    Directory of Open Access Journals (Sweden)

    Andrea Alberti

    2008-06-01

    Full Text Available Andrea Alberti, Maurizio Paciaroni, Valeria Caso, Michele Venti, Francesco Palmerini, Giancarlo AgnelliStroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, ItalyBackground: Early seizure (ES may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the rate of and the predictive factors for ES as well the effects of ES on the clinical outcome at hospital discharge in patients with first-ever stroke.Patients and methods: A total of 638 consecutive patients with first-ever stroke (543 ischemic, 95 hemorrhagic, admitted to our Stroke Unit, were included in this prospective study. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy were excluded.Results: Thirty-one patients (4.8% had ES. Seizures were significantly more common in patients with cortical involvement, severe and large stroke, and in patient with cortical hemorrhagic transformation of ischemic stroke. ES was not associated with an increase in adverse outcome (mortality and disability. After multivariate analysis, hemorrhagic transformation resulted as an independent predictive factor for ES (OR = 6.5; 95% CI: 1.95–22.61; p = 0.003.Conclusion: ES occur in about 5% of patients with acute stroke. In these patients hemorrhagic transformation is a predictive factor for ES. ES does not seem to be associated with an adverse outcome at hospital discharge after acute stroke.Keywords: seizures, stroke, cortical involvement, hemorrhagic transformation

  7. In-hospital medical complications associated with patient dependency after acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; ZHAO Xing-quan; DU Wan-liang; WANG An-xin; JI Rui-jun; YANG Zhong-hua; WANG Chun-xue

    2013-01-01

    Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age >18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80%) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95% confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95% CI 1.922-2.650),and 12 months (adjusted OR 1.820,95% CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.

  8. Sex Disparities in Access to Acute Stroke Care: Can Telemedicine Mitigate this Effect?

    Science.gov (United States)

    Wolff, Catherine; Boehme, Amelia K.; Albright, Karen C.; Wu, Tzu-Ching; Mullen, Michael T.; Branas, Charles C.; Grotta, James C.; Savitz, Sean I.; Carr, Brendan G.

    2016-01-01

    Background Women have more frequent and severe ischemic strokes than men, and are less likely to receive treatment for acute stroke. Primary stroke centers (PSCs) have been shown to utilize treatment more frequently. Further, as telemedicine (TM) has expanded access to acute stroke care we sought to investigate the association between PSC, TM and access to acute stroke care in the state of Texas. Methods Texas hospitals and resources were identified from the 2009 American Hospital Association Annual Survey. Hospitals were categorized as: (1) stand-alone PSCs not using telemedicine for acute stroke care, (2) PSCs using telemedicine for acute stroke care (PSC-TM), (3) non-PSC hospitals using telemedicine for acute stroke care, or (4) non-PSC hospitals not using telemedicine for acute stroke care. The proportion of the population who could reach a PSC within 60 minutes was determined for stand-alone PSCs, PSC-TM, and non-PSCs using TM for stroke care. Results Overall, women were as likely to have 60-minute access to a PSC or PSC-TM as their male counterparts (POR 1.02, 95% CI 1.02-1.03). Women were also just as likely to have access to acute stroke care via PSC or PSC-TM or TM as men (POR 1.03, 95% CI 1.02-1.04). Discussion Our study found no sex disparities in access to stand alone PSCs or to hospitals using TM in the state of Texas. The results of this study suggest that telemedicine can be used as part of an inclusive strategy to improve access to care equally for men and women.

  9. Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy

    NARCIS (Netherlands)

    de Weerd, Leonie; Luijckx, Gert-Jan R.; Groenier, Klaas H.; van der Meer, Klaas

    2012-01-01

    Background: An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after

  10. Noninvasive Ventilatory Correction as an Adjunct to an Experimental Systemic Reperfusion Therapy in Acute Ischemic Stroke

    OpenAIRE

    April Sisson; Alexandrov, Andrei V; Paola Palazzo; Kristian Barlinn; Limin Zhao; Clotilde Balucani

    2010-01-01

    Background. Obstructive sleep apnea (OSA) is a common condition in patients with acute ischemic stroke and associated with early clinical deterioration and poor functional outcome. However, noninvasive ventilatory correction is hardly considered as a complementary treatment option during the treatment phase of acute ischemic stroke. Summary of Case. A 55-year-old woman with an acute middle cerebral artery (MCA) occlusion received intravenous tissue plasminogen activator (tPA) and enrolled int...

  11. Acute Psychosis Associated with Subcortical Stroke: Comparison between Basal Ganglia and Mid-Brain Lesions

    OpenAIRE

    Aaron McMurtray; Ben Tseng; Natalie Diaz; Julia Chung; Bijal Mehta; Erin Saito

    2014-01-01

    Acute onset of psychosis in an older or elderly individual without history of previous psychiatric disorders should prompt a thorough workup for neurologic causes of psychiatric symptoms. This report compares and contrasts clinical features of new onset of psychotic symptoms between two patients, one with an acute basal ganglia hemorrhagic stroke and another with an acute mid-brain ischemic stroke. Delusions and hallucinations due to basal ganglia lesions are theorized to develop as a result ...

  12. Systemic vascular function, measured with forearm flow mediated dilatation, in acute and stable cerebrovascular disease: a case-control study

    Directory of Open Access Journals (Sweden)

    Blacker David

    2010-10-01

    Full Text Available Abstract Background Acute ischaemic stroke is associated with alteration in systemic markers of vascular function. We measured forearm vascular function (using forearm flow mediated dilatation to clarify whether recent acute ischaemic stroke/TIA is associated with impaired systemic vascular function. Methods Prospective case control study enrolling 17 patients with recent acute ischaemic stroke/TIA and 17 sex matched controls with stroke more than two years previously. Forearm vascular function was measured using flow medicated dilatation (FMD. Results Flow mediated dilatation was 6.0 ± 1.1% in acute stroke/TIA patients and 4.7 ± 1.0% among control subjects (p = 0.18. The mean paired difference in FMD between subjects with recent acute stroke and controls was 1.25% (95% CI -0.65, 3.14; p = 0.18. Endothelium independent dilatation was measured in six pairs of participants and was similar in acute stroke/TIA patients (22.6 ± 4.3% and control subjects (19.1 ± 2.6%; p = 0.43. Conclusions Despite the small size of this study, these data indicate that recent acute stroke is not necessarily associated with a clinically important reduction in FMD.

  13. Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy

    OpenAIRE

    de Weerd Leonie; Luijckx Gert-Jan R; Groenier Klaas H; Van der Meer Klaas

    2012-01-01

    Abstract Background An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after thrombolytic treatment. Methods A total of 88 stroke patients were interviewed at home one year post-stroke. Health-related quality of life (HRQOL) was assessed using the RAND-36, disabili...

  14. Anosognosia in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    V. N. Grigoryeva

    2016-01-01

    Full Text Available Objective: to investigate the frequency of anosognosia (a deficit of self-awareness, its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS.Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life.Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD and those with anosognosia and motor dysfunction (AMD had right-sided hemispheric IS more frequently (76% while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction. 

  15. Pilot Scheme of Health Policy in Stroke Adjuvant Acupuncture Therapy for Acute and Subacute Ischemic Stroke in Taiwan

    Directory of Open Access Journals (Sweden)

    Yi-Chia Wei

    2011-01-01

    Twenty-six HPSAAT participants and 52 age-sex matched random controls were enrolled. The stroke baseline of the HPSAAT participants was more severe than the non-HPSAAT controls. Although the stroke severity closely correlates to mortality and comorbidity, this study noted no significant complications in the HPSAAT participants during the acupuncture treatment course. Adjuvant acupuncture was considered safe at the acute and subacute stages of ischemic stroke. Due to uneven baseline severity, the clinical benefits in reducing neurological deficits and functional recovery were not concluded in this study.

  16. Ancrod causes rapid thrombolysis in patients with acute stroke.

    Science.gov (United States)

    Pollak, V E; Glas-Greenwalt, P; Olinger, C P; Wadhwa, N K; Myre, S A

    1990-05-01

    Clot lysis is desirable in patients with thrombi in arteries and arterioles by a safe rapidly-acting thrombolytic agent. Ancrod cleaves fibrinogen; the resulting circulating ancrod-fibrin stimulates fibrinolysis. Ancrod action and effect were studied in 20 patients with acute developing stroke in a double-blind, placebo-controlled study. Patients were randomly assigned to one of two treatment groups, and received either normal saline or ancrod 0.5 mu/kg in normal saline administered as a constant-rate intravenous infusion over 6 hours. Subsequent doses of ancrod (or saline placebo) were determined daily thereafter for a total treatment period of 7 days. Neither bleeding nor re-thrombosis occurred within the 90 day follow-up period. That ancrod acted rapidly was shown by a significant decrease in functional plasminogen activator inhibitor (PA-I) within 60 minutes, and by significant elevations of fibrin(ogen) degradation products (FDP) and D-dimer within 3 and 4 hours. The biological effect of fibrinolysis in ancrod infused patients was demonstrated by a greater improvement in stroke score when compared to those infused with saline. PMID:2186630

  17. Technologies for diagnosis and treatment of acute stroke

    Energy Technology Data Exchange (ETDEWEB)

    Fitch, J.P.

    1998-02-09

    From October 1994 to June 1997, a multidisciplinary team of scientists and engineers at Lawrence Livermore National Laboratory were funded through LDRD to develop and integrate technologies for diagnosis and treatment of acute stroke. The project was summarized in a Science and Technology Review article `Brain Attack` that appeared in June 1997 and again in the Center for Healthcare Technologies Report (UCRL-LR-124761). This article is the best overview of the project, epidemiology of stroke and technical progress. Most of the technical progress has been documented in conference papers and presentations and refereed journal articles. Additional technical publication can be expected as our remaining patent applications progress through the US Patent and Trademark Office. The purpose of this report is to provide an appropriate introduction and organization to the numerous publications so that interested readers can quickly find information. Because there is no documentation for the history of this project, this report provides a summary. It also provides the final status report for the LDRD funding.

  18. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, Alexander D. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Dankbaar, Jan Willem; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Graaf, Yolanda van der [Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Kappelle, L.J. [University Medical Center, Department of Neurology, Utrecht Stroke Center, Utrecht (Netherlands); Collaboration: DUST investigators

    2015-12-15

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  19. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    International Nuclear Information System (INIS)

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  20. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  1. Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

    Science.gov (United States)

    Alberti, Andrea; Paciaroni, Maurizio; Caso, Valeria; Venti, Michele; Palmerini, Francesco; Agnelli, Giancarlo

    2008-01-01

    Background Early seizure (ES) may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the rate of and the predictive factors for ES as well the effects of ES on the clinical outcome at hospital discharge in patients with first-ever stroke. Patients and methods A total of 638 consecutive patients with first-ever stroke (543 ischemic, 95 hemorrhagic), admitted to our Stroke Unit, were included in this prospective study. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy were excluded. Results Thirty-one patients (4.8%) had ES. Seizures were significantly more common in patients with cortical involvement, severe and large stroke, and in patient with cortical hemorrhagic transformation of ischemic stroke. ES was not associated with an increase in adverse outcome (mortality and disability). After multivariate analysis, hemorrhagic transformation resulted as an independent predictive factor for ES (OR = 6.5; 95% CI: 1.95–22.61; p = 0.003). Conclusion ES occur in about 5% of patients with acute stroke. In these patients hemorrhagic transformation is a predictive factor for ES. ES does not seem to be associated with an adverse outcome at hospital discharge after acute stroke. PMID:18827922

  2. Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

    Directory of Open Access Journals (Sweden)

    Kenan Alkhalili

    2014-01-01

    Full Text Available Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

  3. Imaging-based management of acute ischemic stroke patients: current neuroradiological perspectives.

    Science.gov (United States)

    Na, Dong Gyu; Sohn, Chul-Ho; Kim, Eung Yeop

    2015-01-01

    Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.

  4. Imaging-based management of acute ischemic stroke patients: Current neuroradiological perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu [Dept. of Radiology, Neuroradiology, Head and Neck Radiology, Thyroid Radiology Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Sohn, Chul Ho [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Eung Yeop [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2015-04-15

    Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.

  5. Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2014-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers. METHODS: A total of 100 patients with acute...... ischemic stroke or transient ischemic attack admitted to our acute stroke unit wore Actical accelerometers attached to both wrists and ankles and the hip for ≤7 days. Patients were included within 72 hours of symptom onset. Accelerometer output was measured in activity counts (AC). Patients were tested...... daily with Scandinavian Stroke Scale. RESULTS: Physical activity peaked in the morning and declined during the rest of the day. In patients with stroke, total AC were 71% lower than in patients with transient ischemic attack. AC were 80% lower in the paretic compared with those in the nonparetic arm...

  6. Potentially reversible factors during the very acute phase of stroke and their impact on the prognosis

    DEFF Research Database (Denmark)

    Jørgensen, H S; Reith, J; Nakayama, H;

    2001-01-01

    In the Copenhagen Stroke Study, we evaluated the combined impact on stroke outcome of potentially treatable factors such as acute body temperature, blood glucose, and stroke in progression. The patients were stratified into two groups: (1) patients with 'good' prognostic parameters (body...... in progression with an OR of 2.9. However, the combined effect of all three factors was more than additive with an OR of 10.0 (95% CI 1.5-56; p

  7. Matrix Metalloproteinases and Blood-Brain Barrier Disruption in Acute Ischemic Stroke

    OpenAIRE

    Lakhan, Shaheen E.; Kirchgessner, Annette; Tepper, Deborah; Leonard, Aidan

    2013-01-01

    Ischemic stroke continues to be one of the most challenging diseases in translational neurology. Tissue plasminogen activator (tPA) remains the only approved treatment for acute ischemic stroke, but its use is limited to the first hours after stroke onset due to an increased risk of hemorrhagic transformation over time resulting in enhanced brain injury. In this review we discuss the role of matrix metalloproteinases (MMPs) in blood-brain barrier (BBB) disruption as a consequence of ischemic ...

  8. Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

    OpenAIRE

    Andrea Alberti; Maurizio Paciaroni; Valeria Caso; Michele Venti; Francesco Palmerini; Giancarlo Agnelli

    2008-01-01

    Andrea Alberti, Maurizio Paciaroni, Valeria Caso, Michele Venti, Francesco Palmerini, Giancarlo AgnelliStroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, ItalyBackground: Early seizure (ES) may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the rate of and the predictive factors for ES as well the effects of ES on the clinical outcome at hospital discharge in patients with first-ever stroke.Patie...

  9. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W;

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  10. Determinants of fatigue after first-ever ischemic stroke during acute phase.

    Directory of Open Access Journals (Sweden)

    Shan-Shan Wang

    Full Text Available Fatigue after stroke is common and has a negative impact on rehabilitation and survival. However, its pathogenesis and contributing factors remain unclear. The purpose of this study was to identify factors influencing the occurrence of fatigue after first-ever ischemic stroke in acute phase.We examined 265 consecutive patients with first-ever ischemic stroke during acute phase (within 2 weeks in two tertiary stroke care hospitals in Henan, China. We documented patients' demographic and clinical characteristics through face-to-face interviews using structured questionnaires and reviews of medical records. Post-stroke fatigue was defined as a score of ≥4 using the Fatigue Severity Scale. Multivariate logistic regression was used to examine post-stroke fatigue in relation to socio-demographic, lifestyle, clinical characteristics and family function.About 40% first-ever ischemic stroke patients experienced post-stroke fatigue in acute phase. Post-stroke fatigue was associated with lack of exercise before stroke (adjusted odds ratio 4.01, 95% CI 1.95-8.24, family dysfunction (2.63, 1.20-5.80, depression (2.39, 1.02-5.58, the presence of pre-stroke fatigue (4.89, 2.13-11.21, use of sedative medications (4.14, 1.58-10.88, coronary heart disease (3.38, 1.46-7.79 and more severe Modified Rankin Scale (2.55, 1.65-3.95.The causes of post-stroke fatigue are multifaceted. More physical exercise, improving family function, reducing depression and appropriate use of sedative medications may be helpful in preventing post-stroke fatigue.

  11. History, Evolution, and Importance of Emergency Endovascular Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Holodinsky, Jessalyn K; Yu, Amy Y X; Assis, Zarina A; Al Sultan, Abdulaziz S; Menon, Bijoy K; Demchuk, Andrew M; Goyal, Mayank; Hill, Michael D

    2016-05-01

    More than 800,000 people in North America suffer a stroke each year, with ischemic stroke making up the majority of these cases. The outcomes of ischemic stroke range from complete functional and cognitive recovery to severe disability and death; outcome is strongly associated with timely reperfusion treatment. Historically, ischemic stroke has been treated with intravenous thrombolytic agents with moderate success. However, five recently published positive trials have established the efficacy of endovascular treatment in acute ischemic stroke. In this review, we will discuss the history of stroke treatments moving from various intravenous thrombolytic drugs to intra-arterial thrombolysis, early mechanical thrombectomy devices, and finally modern endovascular devices. Early endovascular therapy failures, recent successes, and implications for current ischemic stroke management and future research directions are discussed. PMID:27021771

  12. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2014-10-30

    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

  13. Right Hemispatial Neglect: Frequency and Characterization Following Acute Left Hemisphere Stroke

    Science.gov (United States)

    Kleinman, Jonathan T.; Newhart, Melissa; Davis, Cameron; Heidler-Gary, Jennifer; Gottesman, Rebecca F.; Hillis, Argye E.

    2007-01-01

    The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed…

  14. Occurrence and predictors of persistent impaired glucose tolerance after acute ischemic stroke or transient ischemic attack

    NARCIS (Netherlands)

    S. Fonville (Susanne); H.M. den Hertog (Heleen); A.A.M. Zandbergen (Adrienne); P.J. Koudstaal (Peter Jan); H.F. Lingsma (Hester)

    2014-01-01

    textabstractBackground Impaired glucose tolerance is often present in patients with a transient ischemic attack (TIA) or ischemic stroke and doubles the risk of recurrent stroke. This impaired glucose tolerance can be transient, reflecting an acute stress response, or persistent, representing undiag

  15. Feasibility and safety of inducing modest hypothermia in awake patients with acute stroke through surface cooling

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Rasmussen, B H; Jørgensen, Henrik Stig;

    2000-01-01

    Hypothermia reduces neuronal damage in animal stroke models. Whether hypothermia is neuroprotective in patients with acute stroke remains to be clarified. In this case-control study, we evaluated the feasibility and safety of inducing modest hypothermia by a surface cooling method in awake patients...

  16. Development and Validation of Intracranial Thrombus Segmentation on CT Angiography in Patients with Acute Ischemic Stroke

    NARCIS (Netherlands)

    Santos, E.M.M.; Marquering, H.A.; Berkhemer, O.A.; Van Zwam, W.H.; Van der Lugt, A.; Majoie, C.B.; Niessen, W.J.

    2014-01-01

    Background and Purpose: Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming

  17. Development and validation of intracranial thrombus segmentation on CT angiography in patients with acute ischemic stroke

    NARCIS (Netherlands)

    Santos, E.M.; Marquering, H.A.; Berkhemer, O.A.; Zwam, W.H. van; Lugt, A. van der; Majoie, C.B.; Niessen, W.J.; Dijk, E.J. van

    2014-01-01

    BACKGROUND AND PURPOSE: Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming

  18. STUDY OF RENAL FUNCTION TESTS IN PATIEN TS OF ACUTE HAEMORRHAGIC STROKE

    Directory of Open Access Journals (Sweden)

    Aditya Vardhan

    2015-05-01

    Full Text Available OBJECTIVE: To study renal function tests in patients with acute haemorrhagic stroke and to find association of abnormal renal function with adverse outcome in patients with acute haemorrhagic stroke . MATERIAL AND METHODS: The study was conducted at Darbhanga Medical College & Hospital , Laheriasarai , Darbhanga during the period from January 2012 to September 2013 . This was an observational study . A total of 100 patients presenting with acute haemorrhagic stroke admitted to the hospital or reporting in OPD/Emergency for stroke were included in this study after having taken written informed consent . Cases were selected by random sampling . OBSERVATION: Out of 100 patients with acute haemorrhagic stroke 92 patients had intracerebral haemorrhage and 8 patie nts had subarachnoid haemorrhage . Patients were divided into two groups on the basis of estimated glomerular filtration rate ( eGFR . Group A ( eGFR > 60 ml/min/1 . 73 m 2 BSA comprised of 71% of total stroke patients and group B ( eGFR 98umol/L and 15 ( 68 . 60% patients had blood urea >6 . 8mmol/L . CONCLUSION: This study clearly indicated that renal dysfunction as evidenced by ( a eGFR 98umol/L & c Blood urea >6 . 8mmol/L , are not only an important risk factor for acute haemorrhagic stroke but are also an independent predictor of mortality within 30 days of presentation .

  19. Intra-arterial thrombolysis in acute embolic stroke

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of intra-arterial thrombolysis in acute embolic stroke (AES). Methods: 21 patients with AES were undertaken urokinase or recombinated tissue plasminogen activator through percutaneous femoral intraarterial thrombolysis (IAT) as the treated group, and another 42 patients without thrombolytic treatment were assigned as the control group, which were matched to the baseline National Institutes of Health Stroke Scale (NIHSS) scores with selected gender and age. 24 h NIHSS scores, 90 d modified Rankin Scale (mRS) scores, incidences of hemorrhagic transformation (HT) and mortalities of the two groups were compared after the treatment. Results: (1) The results of cerebral angiography showed that the total re-perfusion rate was 61.90%. The middle cerebral artery (MCA), the internal carotid artery (ICA) and the basilar artery (BA) re-perfusion rates were 83.33%, 28.57% and 50.00%, respectively. (2) The NIHSS scores after 24 h were lower in the treated (IAT) group than those in the control group (12.05±5.61 vs, 14.83±4.05, P<0.05). A favorable outcome (mRS of 0-2) was more frequently observed in the 1AT group (66.67%) than that in the control group (35.71%, P<0.05). (3) There was no significant difference between the rates of HT (28.57% vs. 16.77%) and also the similar mortality rates (19.05% vs. 16.67%) not significant between the two groups. No patient died of HT in both two groups. Conclusion: IAT may be an effective treatment for AES with comparative safety. (authors)

  20. Imaging-Based Management of Acute Ischemic Stroke Patients: Current Neuroradiological Perspectives

    OpenAIRE

    Na, Dong Gyu; Sohn, Chul-Ho; Kim, Eung Yeop

    2015-01-01

    Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials...

  1. The Neuropsychology of Acute Stroke : Characterisation and Prognostic Implications

    NARCIS (Netherlands)

    Nys, G.M.S.

    2005-01-01

    In this thesis, a longitudinal study was performed in a large cohort of patients with a first symptomatic stroke who had no neurological, psychiatric, and/or cognitive history prior to the stroke. The patient cohort was examined in a very early phase (mean interval eight days post-stroke) with a neu

  2. Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

    Directory of Open Access Journals (Sweden)

    Cucalón José M

    2006-02-01

    Full Text Available Abstract Background Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors using the information gathered by primary care practitioners on cardiovascular health of their population. Methods A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses. Results Mean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate

  3. Risk of epileptic seizures onset during acute period of stroke

    OpenAIRE

    I. G. Rudakova; E. Yu. Djachkova; I. G. Kolchu

    2013-01-01

    Stroke is one of the chief cause adults epilepsy. Screening study was performed. Risk factors of early and late after stroke epileptic seizures was studied. It were included 300 patient with different types of stroke, et the age of 41–94. Data of medical history and brain imaging were studied. Results of research were showed: risk of early seizures increase by patients with hemorrhagic stroke, with heart embolic type of ischemic stroke, with combination of cardiac fibrillation and arterial hy...

  4. Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy

    Directory of Open Access Journals (Sweden)

    de Weerd Leonie

    2012-07-01

    Full Text Available Abstract Background An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after thrombolytic treatment. Methods A total of 88 stroke patients were interviewed at home one year post-stroke. Health-related quality of life (HRQOL was assessed using the RAND-36, disability with the Barthel Index, depression and anxiety with the Hospital Anxiety and Depression Scale, and a questionnaire about patient way of life was completed. People aged under 60, moving to a nursing home or with a haemorrhage were excluded. Results The thrombolysis group (TG had more severe stroke (higher NIHSS scores and were younger than the group without thrombolytic therapy (WTG. The primary outcome was HRQOL, which was high and nearly identical in both groups, however the TG had significantly better HRQOL for the ‘mental health’ and ‘vitality’ scales. Patients who stopped or reduced their hobbies because of stroke had a significantly worse HRQOL. One year after stroke, more patients in the TG were totally or severely ADL dependent (12% TG and 0% WTG, p = 0.022. The level of dependence decreased in the TG (p = 0.042 and worsened in the WTG (p  Conclusion No major differences in the primary outcome (HRQOL could be found between the two groups. In addition, no essential difference could be found in mental functioning and participation. We expected that patients undergoing thrombolytic therapy would have worse quality of life because of the greater initial severity of their stroke. Therefore, thrombolytic therapy seems to be of great importance in achieving better quality of life in ischemic stroke patients who respond to this therapy.

  5. Selected acute phase CSF factors in ischemic stroke: findings and prognostic value

    Directory of Open Access Journals (Sweden)

    Intskirveli Nino

    2011-03-01

    Full Text Available Abstract Background Study aimed at investigation of pathogenic role and prognostic value of several selected cerebrospinal fluid acute phase factors that can reflect the severity of ischemic brain damage. Methods Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0. Results At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P Conclusion According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.

  6. Prevalence of microalbuminuria in patients with non-diabetic acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Muralidhara N

    2015-04-01

    Full Text Available Background: Microalbuminuria has been associated with clinical risk factors for stroke like diabetes, hypertension, aging, history of myocardial infarction, obesity, smoking and left ventricular hypertrophy. The present study is aimed to determine the potential use of microalbuminurea, as a marker of stroke risk and its outcome in non-diabetic population. Methods: The present study was conducted in the department of internal medicine and department of neurology after the institutional ethical clearance and the informed consent from all the subjects. A total of 116 patients admitted with acute ischemic stroke presenting within 24 hours of stroke onset were recruited for the study. The microalbuminurea was assayed by immunoprecipitation. The stroke severity was assessed by NIH Stroke Severity Statistical Software Package. P value less than 0.05 was considered the level of significance. Results: There was graded co-relation between NIHSSS score and urine albumin creatinine ratio with significant P value of <0.001 in group A, but no such co-relation was seen in group B (P value 0.2. This suggests more the elevated urine ACR more the neurodefecit implying its utility as prognostic marker in acute ischemic stroke. Conclusion: Urine albumin excretion had the strongest correlation with the NIHSSS Score of the patient in acute ischemic stroke. Therefore, measurement of microalbuminurea may help to assess those who are at increased risk and to triage those who may need a more aggressive management protocol. [Int J Res Med Sci 2015; 3(4.000: 954-957

  7. Medical dispatchers recognise substantial amount of acute stroke during emergency calls

    DEFF Research Database (Denmark)

    Viereck, Søren; Iversen, Helle Klingenberg; Christensen, Hanne Krarup;

    2016-01-01

    stroke are therefore critical in organising emergency stroke care. We aimed to describe the sensitivity and positive predictive value of medical dispatchers' ability to recognise acute stroke during emergency calls, and to identify factors associated with recognition. METHODS: This was an observational......BACKGROUND: Immediate recognition of stroke symptoms is crucial to ensure timely access to revascularisation therapy. Medical dispatchers ensure fast admission to stroke facilities by prioritising the appropriate medical response. Data on medical dispatchers' ability to recognise symptoms of acute...... Dispatch Centre. Sensitivity and positive predictive value were calculated. The effect of age, gender, and time-of-day was analysed using multivariable logistic regression. RESULTS: The sensitivity was 66.2 % (95 % CI: 64.4 %-68.0 %), and the positive predictive value was 30.2 % (95 % CI: 29.1 %-31...

  8. Treatment of acute ischemic stroke: Awareness among general practitioners

    Directory of Open Access Journals (Sweden)

    Aaron S

    2010-01-01

    Full Text Available For promptly referral of a patient with acute ischemic stroke (AIS for possible thrombolysis, general practitioners (GPs need to equipped with the advanced knowledge of AIS treatment. We assessed the knowledge regarding treatment of AIS among GPs practicing in and around a quaternary care teaching hospital in south India. A total of 109 GPs who attend to medical emergencies were interviewed using a standard questionnaire. Of the 109 GPs interviewed, 54% felt that tissue plasminogen activator (tPA can be used in the treating AIS, but only 24% had chosen tPA as the best treatment option and 22% opted for other agents like citicholine or edavarone. Only 17% were aware that tPA should be given within 3 h. and 35% felt that intra-arterial thrombolysis as a treatment option.. Only 30% felt the need for good sugar control and 37% wanted aggressive lowering of blood pressure. Majority of GPs are not clear about beneficial effects of thrombolysis and are not updated regarding BP and sugar control in the setting of AIS.

  9. Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study

    DEFF Research Database (Denmark)

    Jennum, P; Schultz-Larsen, K; Davidsen, Michael;

    1994-01-01

    heart disease (IHD) and stroke while controlling for the potential influence of major cardio- and cerebrovascular risk factors. METHODS. In all, 804 70 year old males and females were classified according to snoring habits. Alcohol and tobacco consumption, blood pressure, body mass index, social group...... among snorers (relative risk [RR] = 1.8; (95% confidence interval: 1.1-3.6). When adjustments were made for the above confounders, no associations could be found between snoring and IHD, stroke or all-cause mortality. CONCLUSIONS. In a 70 year old population, snoring is not associated with an increased......, plasma lipids (triglycerides, cholesterol, high density lipoprotein), fasting blood glucose, plasma epinephrine and norepinephrine were determined at baseline. RESULTS. Over a 6-year period (1984-1990) 88 suffered an IHD episode, 60 had a stroke and 180 died. A slightly higher stroke incidence was found...

  10. Acute Psychosis Associated with Subcortical Stroke: Comparison between Basal Ganglia and Mid-Brain Lesions

    Directory of Open Access Journals (Sweden)

    Aaron McMurtray

    2014-01-01

    Full Text Available Acute onset of psychosis in an older or elderly individual without history of previous psychiatric disorders should prompt a thorough workup for neurologic causes of psychiatric symptoms. This report compares and contrasts clinical features of new onset of psychotic symptoms between two patients, one with an acute basal ganglia hemorrhagic stroke and another with an acute mid-brain ischemic stroke. Delusions and hallucinations due to basal ganglia lesions are theorized to develop as a result of frontal lobe dysfunction causing impairment of reality checking pathways in the brain, while visual hallucinations due to mid-brain lesions are theorized to develop due to dysregulation of inhibitory control of the ponto-geniculate-occipital system. Psychotic symptoms occurring due to stroke demonstrate varied clinical characteristics that depend on the location of the stroke within the brain. Treatment with antipsychotic medications may provide symptomatic relief.

  11. Advances in genomics for ischaemic stroke%缺血性卒中的基因组学研究进展

    Institute of Scientific and Technical Information of China (English)

    潘盼; 宋曼殳

    2012-01-01

    缺血性卒中是导致成年人残疾和死亡的主要疾病之一.年龄、性别、吸烟、高血压和糖尿病等是缺血性卒中的危险因素,但它们仅能部分解释卒中发病的原因.孪生子、家系以及单基因遗传性卒中研究显示,缺血性卒中具有明显的遗传倾向性.近年来,基因组学在缺血性卒中研究中取得了明显进展,并显示许多新的单核苷酸多态性或基因与缺血性卒中及其危险因素有关.然而,这些遗传基因对缺血性卒中的贡献仍然太小,需要重复性研究进一步证实.%Ischemic stroke is one of the major diseases of causing adult disability and death.Age,sex,smoking,hypertension,and diabetes,etc.are the risk factors for ischemic stroke,but they can only partially explain the reasons of stroke onset.Twins,families,and single-gene genetic stroke studies have shown that ischemic stroke has obvious genetic predisposition.In recent years,genomics has made remarkable progress in ischemic stroke study and has shown that many new single nucleotide polymorphisms or genes are associated with ischemic stroke and its risk factors.However,the contribution of these genetic genes for ischemic stroke is still too small and the repetitive studies are needed for further confirmation.

  12. Implication of the recent positive endovascular intervention trials for organizing acute stroke care: European perspective.

    Science.gov (United States)

    Tatlisumak, Turgut

    2015-06-01

    Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion≤6 hours or even beyond from symptom onset and independent of patients' age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide. Now, given the superior benefits of endovascular intervention, the whole structure of acute stroke care needs to be reorganized to meet patient needs and to deliver evidence-based treatments effectively. However, a blueprint for success with novel stroke treatments should be composed of numerous elements and requires efforts from various parties. Regarding the endovascular therapies, the strengths of Europe include highly organized democratic society structures, high rate of urbanization, well-developed revenue-based healthcare systems, and high income levels, whereas the obstacles include the east-west disparity in wealth, the ongoing economic crisis hindering spread of fairly costly new treatments, and the quickly aging population putting more demands on health care in general. Regional and national plans for covering whole population with 24/7 adequate acute stroke care are necessary in close cooperation of professionals and decision-makers. Europe-wide new training programs for expert physicians in stroke care should be initiated shortly. European Stroke Organisation has a unique role in providing expertise, consultation, guidelines, and versatile training in meeting new demands in stroke care. This article discusses the current situation, prospects, and challenges in Europe offering personal views on potential solutions.

  13. Acute care in stroke: the importance of early intervention to achieve better brain protection.

    Science.gov (United States)

    Díez-Tejedor, E; Fuentes, B

    2004-01-01

    It is known that 'time is brain', and only early therapies in acute stroke have been effective, like thrombolysis within the first 3 h, and useful neuroprotective drugs are searched for that probably would be effective only with their very early administration. General care (respiratory and cardiac care, fluid and metabolic management, especially blood glucose and blood pressure control, early treatment of hyperthermia, and prevention and treatment of neurological and systemic complications) in acute stroke patients is essential and must already start in the prehospital setting and continue at the patient's arrival to hospital in the emergency room and in the stroke unit. A review of published studies analyzing the influence of general care on stroke outcome and the personal experience from observational studies was performed. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis after correcting for age, stroke severity, and stroke subtype. Although a clinical trial of glucose-insulin-potassium infusions is ongoing, increased plasma glucose levels should be treated. Moreover, insulin therapy in critically ill patients, including stroke patients, is safe and determines lower mortality and complication rates. Both high and low blood pressure levels have been related to a poor prognosis in acute stroke, although the target levels have not been defined yet in clinical trials. The body temperature has been shown to have a negative effect on stroke outcome, and its control and early treatment of hyperthermia are important. Hypoxemia also worsens the stroke prognosis, and oxygen therapy in case of prehospital level from the very beginning. This could help to save more brain tissue to get the best conditions for further specific stroke therapies such as the use of neuroprotective or thrombolytic drugs in the hospital. PMID:14694290

  14. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A;

    2011-01-01

    in Stroke-International Stroke Thrombolysis Register) compared to nonthrombolyzed controls (C; data from Virtual International Stroke Trials Archive). METHODS: We selected ischemic stroke patients on whom we held data on age, baseline NIH Stroke Scale score (NIHSS), and 90-day modified Rankin Scale score (m......BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......RS). We compared the distribution of mRS between T and C by Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression, after adjustment for age and baseline NIHSS, in patients with and without DM, PS, or the combination. We report odds ratios (OR) for improved distribution of m...

  15. Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

    Directory of Open Access Journals (Sweden)

    Atay Vural

    2016-04-01

    Full Text Available Objective: Stroke is one of the most important public health issues worldwide, and ranks as the second highest cause of mortality in our country. Regular follow-up of stroke statistics and taking necessary precautions upon determining deficits by countries themselves constitute the most important way of improving prognosis and survival after stroke incidents. To achieve this goal, statistical studies should be performed at various levels of healthcare services. Tertiary care hospitals are the most suitable centers to perform these studies. However, the majority of the population receives service at secondary care centers where the actual statistics remain unknown. The objective of this study was to examine all patients with acute stroke who presented to a county hospital over a one-year period and obtain related data, discuss deficits, and provide solutionbased recommendations. Materials and Methods: All patients diagnosed as having acute stroke between July 2013-July 2014 were included in the study. Demographic, clinical, and radiologic data, in addition to the timing of presentation and baseline National Institutes of Health Stroke Scale (NIHSS scores were recorded retrospectively, and patients were classified by the type of stroke. All patients were followed up for at least one year after the stroke incident and cumulative survival scores were calculated using Kaplan-Meier analysis. Results: Hemorrhagic stroke was determined in four out of 49 patients with acute stroke; the 45 patients diagnosed as having ischemic stroke were included in the study. Among these, 44.4% (n=20 of the patients presented within the first three hours of onset of clinical symptoms, 4.4% (n=2 presented at 3.-4.5 hours. Baseline NIHSS was 1-4 (mild stroke in 50% (n=10 of patients who presented in the first three hours, and >5 (moderate or severe stroke in 50% (n=10 of the remaining patients. The etiologic cause was embolic in 37.1% (n=13, large artery atherosclerosis

  16. Functional COMT Val158Met polymorphism, risk of acute coronary events and serum homocysteine: the Kuopio ischaemic heart disease risk factor study.

    Directory of Open Access Journals (Sweden)

    Sari Voutilainen

    Full Text Available BACKGROUND: The role of circulating levels of total homocysteine tHcy in the development of coronary heart disease (CHD is still under debate. One reason for conflicting results between previous studies on homocysteine and heart diseases could be consequence of different interactions between homocysteine and genes in different study populations. Many genetic factors play a role in folate-homocysteine metabolism, like functional polymorphism (Val108Met in the Catechol-O-methyltransferase (COMT gene. METHODOLOGY AND FINDINGS: Our aim was to examine the role of COMT Val158Met polymorphism and interaction of this polymorphism with serum tHcy and folate concentration on the risk of acute coronary and events in middle-aged men from eastern Finland. A population-based prospective cohort of 792 men aged 46-64 years was examined as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. During an average follow-up of 9.3 years, there were 69 acute coronary events in men with no previous history of CHD. When comparing the COMT low activity genotype with the others, we found an age and examination year adjusted hazard rate ratio (HRR of 1.73 (95% confidence interval (CI, 1.07-2.79, and an age, examination year, serum LDL and HDL cholesterol, and triglyceride concentration, systolic blood pressure and smoking adjusted HRR of 1.77 (95% CI, 1.05-2.77. Although serum tHcy concentration was not statistically significantly associated with acute coronary events (HRR for the highest third versus others 1.52, 95% CI, 0.93-2.49, subjects with both high serum tHcy and the COMT low activity genotype had an additionally increased adjusted risk of HRR 2.94 (95% CI 1.50-5.76 as compared with other men. CONCLUSIONS: This prospective cohort study suggests that the functional COMT Val158Met polymorphism is associated with increased risk of acute coronary events and it may interact with high serum tHcy levels.

  17. Angiotensin receptor blockade in acute stroke. The Scandinavian Candesartan Acute Stroke Trial: rationale, methods and design of a multicentre, randomised- and placebo-controlled clinical trial (NCT00120003)

    DEFF Research Database (Denmark)

    Sandset, Else Charlotte; Murray, Gordon; Boysen, Gudrun Margrethe;

    2010-01-01

    Elevated blood pressure following acute stroke is common, and yet early antihypertensive treatment is controversial. ACCESS suggested a beneficial effect of the angiotensin receptor blocker candesartan in the acute phase of stroke, but these findings need to be confirmed in new, large trials. AIM...... variables: Secondary effect variables include • the Barthel index (functional status) • EuroQol (quality of life) and • Mini-mental state examination (cognition) at 6-months • Health economic costs during the first 6-months......, Sweden, Denmark, Belgium, Germany, Poland, Lithuania, Estonia and Finland. STUDY OUTCOMES: There are two co-primary effect variables: • Functional status at 6-months, measured by the modified Rankin Scale, and • vascular death, myocardial infarction or stroke during the first 6-months. Secondary outcome...

  18. Spontaneous Low Frequency Oscillations in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Phillip, Dorte; Schytz, Henrik Winther; Iversen, Helle Klingenberg;

    2014-01-01

    .09-0.11 Hz range are affected by changes in cerebral autoregulation (CA), which is altered following stroke. We examined oxyHb LFOs at bed-side as a marker of CA in the subacute phase in stroke patients with or without recombinant tissue plasminogen activator thrombolytic therapy. Methods: We recruited 29...... patients admitted to the stroke unit with symptoms of ischemic stroke. 11/29 patients received thrombolytic therapy. NIRS examination was conducted 2 days (median time) from stroke onset. NIRS optodes were placed on each side of the head with a 3 cm source-detector distance. Using transfer function...... analysis, inter-hemispheric phase shift and amplitude ratio of the oxyHb oscillations in the 0.09-0.11 Hz range were assessed. Results: The correlation between NIHSS scores at admission and oxyHb parameters revealed a significant positive correlation between stroke severity at admission and inter...

  19. Cortisol levels and the severity and outcomes of acute stroke: a systematic review.

    Science.gov (United States)

    Barugh, Amanda Jayne; Gray, Paul; Shenkin, Susan Deborah; MacLullich, Alasdair Maurice Joseph; Mead, Gillian Elizabeth

    2014-03-01

    Studies in non-stroke patients have shown an association between dysregulation of the hypothalamic-pituitary-adrenal axis and morbidity and mortality. We conducted a systematic review to evaluate cortisol levels in acute stroke and their associations with outcome. We searched MEDLINE and EMBASE for articles up to April 2013 and PsychINFO for articles up to July 2013, using the keywords "cortisol" and "stroke" and associated terms or synonyms. We included studies published in peer-reviewed journals that recruited 10 or more participants and measured cortisol at least once in the first year following stroke. Data were extracted regarding cortisol levels, including changes over time and their relationship to stroke severity, and outcome. Of 11,240 abstracts, 101 full texts were obtained and 48 fulfilled our inclusion criteria. Cortisol levels were high in the first week after stroke in the majority of studies (26 studies, n = 1,340). Higher cortisol was associated with dependency (8/11 studies, n = 822), delirium (5/6 studies, n = 269) depression (3/5 studies n = 117) and mortality (8/10 studies, n = 856). Five studies adjusted for stroke severity; one found an association between higher cortisol and dependency, and three found an association between higher cortisol and mortality. Cortisol levels are high for at least 7 days after stroke. Elevated cortisol after stroke is associated with dependency, morbidity, and mortality; however, there is insufficient evidence to conclude that these relationships are independent of stroke severity.

  20. Soluble CXCL16 and long-term outcome in acute ischemic stroke

    DEFF Research Database (Denmark)

    Ueland, T; Smedbakken, L M; Hallén, J;

    2012-01-01

    CXCL16 is a chemokine involved in atherosclerosis by promoting inflammation, lipid accumulation and matrix degradation. The level of circulating CXCL16 has been proposed as a predictor of long-term mortality in acute coronary syndromes. We studied plasma CXCL16 in acute ischemic stroke and examined...

  1. Noninvasive Ventilatory Correction as an Adjunct to an Experimental Systemic Reperfusion Therapy in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Kristian Barlinn

    2010-01-01

    Full Text Available Background. Obstructive sleep apnea (OSA is a common condition in patients with acute ischemic stroke and associated with early clinical deterioration and poor functional outcome. However, noninvasive ventilatory correction is hardly considered as a complementary treatment option during the treatment phase of acute ischemic stroke. Summary of Case. A 55-year-old woman with an acute middle cerebral artery (MCA occlusion received intravenous tissue plasminogen activator (tPA and enrolled into a thrombolytic research study. During tPA infusion, she became drowsy, developed apnea episodes, desaturated and neurologically deteriorated without recanalization, re-occlusion or intracerebral hemorrhage. Urgent noninvasive ventilatory correction with biphasic positive airway pressure (BiPAP reversed neurological fluctuation. Her MCA completely recanalized 24 hours later. Conclusions. Noninvasive ventilatory correction should be considered more aggressively as a complementary treatment option in selected acute stroke patients. Early initiation of BiPAP can stabilize cerebral hemodynamics and may unmask the true potential of other therapies.

  2. Acute but not delayed amphetamine treatment improves behavioral outcome in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, Karsten; Kristiansen, Uffe;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph-facilitate......OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph......: In conclusion, results showed that the acute amph group performed the best, while the late amph and the combination groups performed the worst. Amphetamine treatment in acute stroke may be warranted due to reduced detrimental effects of hypotension and improved brain plasticity....

  3. Association between Oxidative Stress and Outcome in Different Subtypes of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Nai-Wen Tsai

    2014-01-01

    Full Text Available Objectives. This study investigated serum thiobarbituric acid-reactive substances (TBARS and free thiol levels in different subtypes of acute ischemic stroke (AIS and evaluated their association with clinical outcomes. Methods. This prospective study evaluated 100 AIS patients, including 75 with small-vessel and 25 with large-vessel diseases. Serum oxidative stress (TBARS and antioxidant (thiol were determined within 48 hours and days 7 and 30 after stroke. For comparison, 80 age- and sex-matched participants were evaluated as controls. Results. Serum TBARS was significantly higher and free thiol was lower in stroke patients than in the controls on days 1 and 7 after AIS. The level of free thiol was significantly lower in the large-vessel disease than in the small-vessel disease on day 7 after stroke. Using the stepwise logistic regression model for potential variables, only stroke subtype, NIHSS score, and serum TBARS level were independently associated with three-month outcome. Higher TBARS and lower thiol levels in the acute phase of stroke were associated with poor outcome. Conclusions. Patients with large-vessel disease have higher oxidative stress but lower antioxidant defense compared to those with small-vessel disease after AIS. Serum TBARS level at the acute phase of stroke is a potential predictor for three-month outcome.

  4. Low dose CT perfusion in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Amanda; Symons, Sean; Jakubovic, Raphael; Zhang, Liying; Aviv, Richard I. [Sunnybrook Health Sciences Centre, Toronto, ON (Canada); So, Aaron; Lee, Ting-Yim [Robarts Research Institute, London, Ontario (Canada)

    2014-12-15

    The purpose of this investigation is to determine if CT perfusion (CTP) measurements at low doses (LD = 20 or 50 mAs) are similar to those obtained at regular doses (RD = 100 mAs), with and without the addition of adaptive statistical iterative reconstruction (ASIR). A single-center, prospective study was performed in patients with acute ischemic stroke (n = 37; 54 % male; age = 74 ± 15 years). Two CTP scans were performed on each subject: one at 100 mAs (RD) and one at either 50 or 20 mAs (LD). CTP parameters were compared between the RD and LD scans in regions of ischemia, infarction, and normal tissue. Differences were determined using a within-subjects ANOVA (p < 0.05) followed by a paired t test post hoc analysis (p < 0.01). At 50 mAs, there was no significant difference between cerebral blood flow (CBF), cerebral blood volume (CBV), or time to maximum enhancement (Tmax) values for the RD and LD scans in the ischemic, infarcted, or normal contralateral regions (p < 0.05). At 20 mAs, there were significant differences between the RD and LD scans for all parameters in the ischemic and normal tissue regions (p > 0.05). CTP-derived CBF and CBV are not different at 50 mAs compared to 100 mAs, even without the addition of ASIR. Current CTP protocols can be modified to reduce the effective dose by 50 % without altering CTP measurements. (orig.)

  5. Patterns of regional cerebral blood flow in acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Skriver, E B

    1981-01-01

    In a consecutive group of 56 stroke patients the regional cerebral blood flow was measured within 84 hours after stroke. A 254 multidetector scintillation camera and the intracarotid Xenon-133 injection method was used to study rCBF. Typical rCBF-patterns are described and compared to the findings...

  6. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Z; Hundborg, Heidi;

    2014-01-01

    BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding......, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used...... to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long...

  7. Report of moderate or severe sodium and chloride disturbance on 82 cases with acute cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    Ma shun-tian

    2000-01-01

    Abtract Objective: To decrease the fatality rate and prevalence rotc of acute cerebral stroke complicated with morderate or servere serum sodium and chioride disturbance by explonng the relation between the pathogency and prognosis Methods: Medical records were surveyed and clinical presentation, laboratory test, complicated。 Actiology pathogency and prognosis were analyzed m 82 cases with moderate or severe serum sodium and chloride disturbance among 736 cases with acute cerebral stroke collected, Results: The prevalence rate and fatality rate of acutc cerebral stroke complicated with moderate or severe serum sodium and chlorede disturbance were 11.3% (82/ 736) and 60.8% (49/52) which were different significantly form that complicated with normal or minimal sedium sodium and chloride disturbame (p (0.001) 。 The 82 cases occured at 3-13 days after hospitalization (mean 6 days) 。 The actiology and pathogency were mainly ralated with some endogenic and iatrogenic factors such as hypothalamic-pituitary system were destroyed resultly from acute cerbral stroke which led to SIADH。 Conclusion: The fatality rate of acute cerebral stroke complicatee with moderate or seyere serum sodium and chloride disturbance is mcreased significantly, Put prophylaxis first to decrease the prevalence rate and fatalty rate。 Pay attlention to comprehensive therapy of acute cerebral stoke to prevent endogenic sodium and chloride disturbance and especially place importance on iatrogenic disturbance。

  8. Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy.

    Science.gov (United States)

    Huang, Kun-Ling; Liu, Ting-Yuan; Huang, Yu-Chi; Leong, Chau-Peng; Lin, Wei-Che; Pong, Ya-Ping

    2014-01-01

    Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration-aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P swallowing therapy in taking solid diets and thick liquids.

  9. Strokes in adults.

    Science.gov (United States)

    Pearce, Lynne

    2016-06-15

    Essential facts There are two types of stroke - around 85% are ischaemic and 15% are haemorrhagic. According to the Stroke Association's State of the Nation report, published in January 2016, stroke occurs around 152,000 times a year in the UK. It is the fourth largest cause of death in the UK and one of the largest causes of disability. PMID:27305230

  10. Strong complement activation after acute ischemic stroke is associated with unfavorable outcomes

    DEFF Research Database (Denmark)

    Széplaki, Gábor; Szegedi, Róbert; Hirschberg, Kristóf;

    2009-01-01

    five complement activation products (C1rC1sC1inh, C4d, C3a, C5a and SC5b-9) in samples of 26 patients with ischemic stroke upon admission. Twenty-six patients with severe carotid atherosclerosis served as patient controls. RESULTS: Levels of two activation products (SC5b-9 and C4d)) were significantly......OBJECTIVE: According to data from animal models, complement activation plays a major role in the brain injury after acute ischemic stroke. Scarce findings are, however, available on the detection of complement activation products in stroke patients. METHODS: We have measured plasma levels of the...... elevated in the plasma of stroke patients, SC5b-9 levels, exhibited significant positive correlation with the clinical severity of stroke, the severity of neurological deficit, as well as with the level of functional disability. CONCLUSION: These findings suggest that complement activation plays an active...

  11. Erythropoiesis-stimulating agents increase the risk of acute stroke in patients with chronic kidney disease

    Science.gov (United States)

    Seliger, Stephen L.; Zhang, Amy D.; Weir, Matthew R.; Walker, Loreen; Hsu, Van Doren; Parsa, Afshin; Diamantidis, Clarissa; Fink, Jeffrey C.

    2013-01-01

    Erythropoiesis-stimulating agents (ESAs) are effective in ameliorating anemia in chronic kidney disease (CKD). However, a recent trial in diabetic CKD patients suggested a greater stroke risk associated with full correction of anemia using ESAs. We performed a case-control study examining the association of incident ESA use with acute stroke in CKD patients, using national Veterans Affairs data. Patients with eGFR<60 cc/min/1.73m2 and outpatient hemoglobin (Hb)<12g/dL were included. Acute hospitalized stroke cases (N=2071) were identified using diagnosis codes and matched 1:5 to controls without stroke. Conditional logistic regression was used to estimate the association of ESA use with stroke, adjusting for potential confounders. After multivariate adjustment, ESA use (N=1026, 8.3%) was associated with 30% greater odds of stroke (odds ratio[OR]=1.30, 95% confidence interval[CI]: 1.06, 1.58). There was significant interaction (p=.015) between ESA use and cancer; ESA use was associated with 85% greater odds of stroke in cancer patients (95% CI: 1.26, 2.65), but not associated with stroke in patients without cancer (OR=1.07, 95% CI: 0.85, 1.35). ESA-treated patients with cancer received a median initial dose 2.5 to 4 times greater than ESA patients without cancer, but pre-ESA Hb and rate of Hb change did not differ between groups. Among a large national sample of anemic CKD patients, ESA treatment is associated with an increased risk of acute stroke, with the greatest effect among patients with cancer. PMID:21389972

  12. Erythrocyte sedimentation rate: Can be a prognostic marker in acute ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Selim Selçuk Çomoğlu

    2013-01-01

    Full Text Available OBJECTIVE: The aim of this study is to investigate the relationship between the erythrocyte sedimentation rate (ESR values and the severity of neurological findings on admission, short- term prognosis, risk factors and etiology of the patients with acute ischemic stroke. MATERIAL and METHODS: One hundred and fifty-eight consecutive patients who admitted to the hospital within 24 hours of stroke onset were retrospectively analyzed. National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (mRS scores on admission and mRS scores at discharge, brain imaging findings, stroke etiology and risk factors of the patients were recorded. Patients were classified into three groups according to ESR values on admission and compared in terms of severity of clinical symptoms on admission, short-term prognosis, risk factors and etiology of stroke. RESULTS: A total 158 patients with acute ischemic stroke including 89 women and 69 men were enrolled in the study. Patients with ESR≤10 mm/h were included in group 1 (n=49, ESR levels between 11-25 mm/h were included in group 2 (n=69 and ESR≥26 mm/h were included in group 3 (n=40. No significant difference was determined between the groups in terms of NIHSS and mRS scores on admission and mRS scores at discharge and etiology of stroke. While coronary artery disease was found more frequently in group 1 and 2 than group 3 (p=0.018, valvular heart disease was more frequently in group 2 than group 1 (p=0.037. CONCLUSION: The results of our study revealed that ESR levels on admission do not reflect the severity of stroke and can not be accepted as a useful predictor of short-term prognosis in patients with acute ischemic stroke.

  13. CT Perfusion ASPECTS in the Evaluation of Acute Ischemic Stroke: Thrombolytic Therapy Perspective

    OpenAIRE

    Sillanpaa, Niko; Saarinen, Jukka T.; Rusanen, Harri; Hakomaki, Jari; Lahteela, Arto; Numminen, Heikki; Elovaara, Irina; Dastidar, Prasun; Soimakallio, Seppo

    2011-01-01

    Background and Purpose Advances in the management of acute ischemic stroke and medical imaging are creating pressure to replace the rigid one-third middle cerebral artery (MCA) and non-contrast-enhanced CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS) thresholds used for the selection of patients eligible for intravenous thrombolytic therapy. The identification of potentially salvageable ischemic brain tissue lies at the core of this issue. In this study, the role of CT perfusion ASP...

  14. Acute Hepatic Failure as a Leading Manifestation in Exertional Heat Stroke

    OpenAIRE

    Qi Jin; Erzhen Chen; Jie Jiang; Yiming Lu

    2012-01-01

    Background. Acute hepatic failure (AHF) is uncommon as a leading symptom in patients with exertional heat stroke (EHS). Which stage to perform the liver transplantation for severe hepatic failure in EHS is still obscure at clinical setting. The conservative management has been reported to be successful in treating heat-stroke-associated AHF even in the presence of accepted criteria for emergency liver transplantation. Case Presentation. Here, we reported a 35-year-old male who presented with ...

  15. Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

    OpenAIRE

    Gentil, Arnaud; Béjot, Yannick; Lorgis, Luc; Durier, Jérôme; Zeller, Marianne; Osseby, Guy-Victor; Dentan, Gilles; Beer, Jean-Claude; Moreau, Thibault; Giroud, Maurice; Cottin, Yves

    2009-01-01

    Abstract Background: Despite a common pathophysiological mechanism, i.e. atherosclerosis, and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI). Methods: We prospectively recorded all first-ever cases of stroke and AMI in Dijon, France (151,846 inhabitants) from 2001 to 2006. The 30-day case fatality rates (CFR) and the vascular risk factors were assessed in both groups. Results: ...

  16. Disruption of brain connectivity in acute stroke patients with early impairment in consciousness

    Directory of Open Access Journals (Sweden)

    Yuan-Hsiung eTsai

    2014-01-01

    Full Text Available Impairment in consciousness is common in acute stroke patients and is correlated with the clinical outcome after stroke. The underlying mechanism is not completely understood, with little known about brain activity and connectivity changes in acute stroke patients having impaired consciousness. In this study, we investigated changes in regional brain activity and brain networks of consciousness impaired stroke patients, as well as the amplitude of spontaneous low frequency fluctuation (ALFF of each time series. Regional homogeneity (ReHo of each voxel was measured, and resting state network analysis was consequently conducted. Results from this study demonstrate that, compared to normal subjects, the intensities of ALFF and ReHo, as well as the strength of the default mode network (DMN connectivity, were significantly decreased in the precuneus and posterior cingulate cortex regions among stroke patients with impaired consciousness. Furthermore, the strength of the DMN was highly correlated with differences in the Glasgow Coma Scale (GCS scores between the onset time and the scanning time. Results from this study suggest that the resting state fMRI is a feasible tool for the evaluation of acute stroke patients with an early impairment of consciousness. The detailed mechanisms, implications of these brain activities and networks exhibiting changes will require further investigation.

  17. Thrombolytic therapy. From myocardial to cerebral infarction. The MAST-I Group. Multicentre Acute Stroke Trial.

    Science.gov (United States)

    Candelise, L; Roncaglioni, C; Aritzu, E; Ciccone, A; Maggioni, A P

    1996-02-01

    Thrombolysis is proposed for the acute treatment of cerebral infarction as it is able to recanalize occluded arteries and thus potentially restore normal perfusion of the cerebral parenchyma, but the results concerning the efficacy of this treatment are still inconclusive. However, it has been fully demonstrated that thrombolytic treatment, leads to a significant reduction in mortality, in patients with acute myocardial infarction. Data from all of the pilot studies using SK or tPA treatment in acute stroke are described in this review, which underlines the incidence of hemorrhagic transformation (hemorrhagic infart and parenchymal hematoma) and its possible correlation to clinical worsening. Pharmacological, experimental and clinical studies encourage the carrying out of large-scale clinical trials using thrombolytics in patients with acute cerebral infarction. Significant data relating to ongoing controlled clinical trials will be available in the near future; only after the analysis of these results will it be possible to confirm the efficacy of thrombolytics in acute stroke.

  18. Developing drug strategies for the neuroprotective treatment of acute ischemic stroke.

    Science.gov (United States)

    Tuttolomondo, Antonino; Pecoraro, Rosaria; Arnao, Valentina; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio

    2015-01-01

    Developing new treatment strategies for acute ischemic stroke in the last twenty years has offered some important successes, but also several failures. Most trials of neuroprotective therapies have been uniformly negative to date. Recent research has reported how excitatory amino acids act as the major excitatory neurotransmitters in the cerebral cortex and hippocampus. Furthermore, other therapeutic targets such as free radical scavenger strategies and the anti-inflammatory neuroprotective strategy have been evaluated with conflicting data in animal models and human subjects with acute ischemic stroke. Whereas promising combinations of neuroprotection and neurorecovery, such as citicoline, albumin and cerebrolysin have been tested with findings worthy of further evaluation in larger randomized clinical trials. Understanding the complexities of the ischemic cascade is essential to developing pharmacological targets for acute ischemic stroke in neuroprotective or flow restoration therapeutic strategies. PMID:26469760

  19. [Stroke from the Perspective of Neurologists (Part 1): Update in the Acute Diagnosis].

    Science.gov (United States)

    Schur, Patrick; Luft, Andreas

    2016-04-27

    Stroke care is rapidly changing. The next three «Praxis» editions will give you an update and the neurological perspective of stroke including acute diagnosis, acute therapy and secondary prevention. The first article focuses on diagnostic procedures in the acute stage. In spite of the tremendous progress stroke remains frequent and the major cause of adult-onset disability. The pathophysiological correlate is the cerebral ischemia or the cerebral bleeding, which are in most reason responsible for persistent disability and high health care and social costs. The shortest work-up to the right diagnoses and the favored therapies can save life and improve quality of daily living. The rapid clinical and radiological identification of the target groups which benefit is essential. In the last years several randomized controlled studies show new medical evidence. PMID:27120210

  20. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel;

    2015-01-01

    -term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78......Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long...

  1. Endovascular therapy in acute ischemic stroke: The way forward after results from the IMS 3, SYNTHESIS and MR Rescue trials

    Directory of Open Access Journals (Sweden)

    Bijoy K Menon

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  2. Involvement of the Hippo pathway in regeneration and fibrogenesis after ischaemic acute kidney injury: YAP is the key effector.

    Science.gov (United States)

    Xu, Jing; Li, Pei-Xue; Wu, Jun; Gao, Yi-Jun; Yin, Meng-Xin; Lin, Ye; Yang, Ming; Chen, Dong-Ping; Sun, Hai-Peng; Liu, Zeng-Bo; Gu, Xiang-Chen; Huang, Hong-Ling; Fu, Li-Li; Hu, Hui-Min; He, Liang-Liang; Wu, Wen-Qing; Fei, Zhao-Liang; Ji, Hong-Bin; Zhang, Lei; Mei, Chang-Lin

    2016-03-01

    Renal tubule cells can recover after they undergo AKI (acute kidney injury). An incomplete repair of renal tubules can result in progressive fibrotic CKD (chronic kidney disease). Studies have revealed the relationship between tubular epithelial cells and kidney fibrogenesis. However, the underlying mechanism remains unclear. Hippo pathway components were evaluated in complete/incomplete repair of I/R (ischaemia/reperfusion) AKI rat models, HK-2 cells and AKI human renal biopsy samples. We found that the expression levels of the Hippo pathway components changed dynamically during kidney regeneration and fibrogenesis in rat models of I/R-induced AKI and human renal biopsy samples. The transcription cofactor YAP (Yes-associated protein) might be a key effector of renal regeneration and fibrogenesis. Our results showed further that YAP might elicit both beneficial and detrimental effects on I/R AKI. After I/R injury occurred, YAP could promote the repair of the injured epithelia. The constant YAP increase and activation might be related to interstitial fibrosis and abnormal renal tubule differentiation. These results indicate that the proper modulation of the Hippo pathway, specifically the transcription cofactor YAP, during repair might be a potent therapeutic target in AKI-CKD transition after I/R injury.

  3. Prehospital and in-hospital delays in acute stroke care.

    Science.gov (United States)

    Evenson, K R; Rosamond, W D; Morris, D L

    2001-05-01

    Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions to reduce delay time and to raise several key issues which future studies should consider. A comprehensive search was performed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, including intervention studies. Since 1981, at least 48 unique reports of prehospital delay time for patients with stroke, transient ischemic attack, or stroke-like symptoms were published from 17 different countries. In the majority of studies which reported median delay times, the median time from symptom onset to arrival in the emergency department was between 3 and 6 h. The in-hospital times from emergency department arrival to being seen by an emergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently longer than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologies differed across studies, making direct comparisons difficult. This review suggests that the majority of stroke patients are unlikely to arrive at the emergency department and receive a diagnostic evaluation in under 3 h. Further studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies. PMID:11359072

  4. Selection of acute stroke patients for treatment of visual neglect.

    OpenAIRE

    Stone, S P; Patel, P.; Greenwood, R J

    1993-01-01

    Although visual neglect is a predictor of poor outcome after stroke, some patients regain independence, whilst others take up considerable rehabilitation resources. Intensive treatment of visual neglect is available and a knowledge of the predictive features in the recovery of these patients would be helpful in the early selection of patients for treatment. A study was therefore carried out to determine the prognosis of patients presenting with visual neglect at two to three days after stroke...

  5. Spontaneous coronary artery dissection presenting as an ischaemic stroke in a middle-aged man with anti-cardiolipin antibodies: a case report

    Directory of Open Access Journals (Sweden)

    Lim F

    2010-03-01

    Full Text Available Abstract Introduction Cerebrovascular disease is a major cause of mortality and morbidity worldwide. Ischemic stroke is the most common manifestation, encompassing a wide variety of causative mechanisms. We present the case of a middle-aged male patient with spontaneous coronary artery dissection in the presence of anti-cardiolipin antibodies, leading to left ventricular thrombus and presenting with stroke. Case presentation A 56-year-old Caucasian man presented with dysarthria and right-sided weakness. There was a history of chest pain with autonomic symptoms four days earlier. Examination revealed right-sided hemiparesis. Electrocardiogram showed sinus rhythm with anterior Q waves. Magnetic resonance imaging of the brain showed large left parietal and smaller multiple cerebral infarcts. Echocardiogram showed anterior wall and apical akinesis with a large mural thrombus. Anti-cardiolipin antibodies immunoglobulin G and immunoglobulin M were strongly positive. Coronary angiography showed dissection of the mid left anterior descending artery with normal flow down the distal vessel. He was treated conservatively with anticoagulation and secondary prevention. He was in good health when seen in clinic four months later. Conclusion We highlight the importance of a comprehensive approach at obtaining the correct diagnosis, input of different specialities and the fact that the presence of anti-cardiolipin antibodies is associated with coronary artery dissection in a middle-aged male patient whose presentation was stroke.

  6. Neurological deterioration in the acute phase of minor ischemic stroke is an independent predictor of poor outcomes at 1 year: results from the China National Stroke Registry (CNSR)

    Institute of Scientific and Technical Information of China (English)

    JU Yi; ZHAO Xing-quan; WANG Chun-xue; WANG Yi-long; LIU Gai-fen; WANG Yong-jun

    2013-01-01

    Background The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms.The impact of this clinical deterioration on long-term outcomes is unknown.We characterized the clinical features of neurological deterioration (ND) in the acute phase of minor ischemic stroke (MIS) and investigated its impact on mid-and long-term outcomes.Methods This was a multi-centered,prospective clinical study involving patients with MIS (the National Institutes of Health Stroke Scale,NIHSS <3) recruited from the China National Stroke Registry.Patients were included who had been hospitalized within 24 hours of stroke onset.Baseline characteristics,complication rates during hospitalization,etiology of stroke,as well as 3-,6-,and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase.Results A number of 368 (15.2%) out of 2424 patients included in the study exhibited ND in the acute phase.Compared to patients without ND,patients with ND had longer hospital stay,increased rate of baseline diabetes,and multiple complications.Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence (adjusted odds ratio =5.20,95% Cl,3.51-7.70,P <0.001) at 12-month post-stroke.Conclusions The risk of ND in the acute phase is high in patients with MIS.ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.

  7. Music as Medicine: The Therapeutic Potential of Music for Acute Stroke Patients.

    Science.gov (United States)

    Supnet, Charlene; Crow, April; Stutzman, Sonja; Olson, DaiWai

    2016-04-01

    Nurses caring for patients with acute stroke are likely to administer both music and medication with therapeutic intent. The administration of medication is based on accumulated scientific evidence and tailored to the needs of each patient. However, the therapeutic use of music is generally based on good intentions and anecdotal evidence. This review summarizes and examines the current literature regarding the effectiveness of music in the treatment of critically ill patients and the use of music in neurologically injured patients. The rationale for hypothesis-driven research to explore therapeutic music intervention in acute stroke is compelling. PMID:27037347

  8. Weekend Admission in Patients with Acute Ischemic Stroke Is Not Associated with Poor Functional Outcome than Weekday Admission

    OpenAIRE

    Kim, Sang-Chul; Hong, Keun-Sik; Hwang, Seon-Il; KIM, Ji-Eun; Kim, Ah-Ro; Cho, Joong-Yang; Park, Hee Kyung; Park, Ji-Hyun; Koo, Ja-Seong; Park, Jong-Moo; Bae, Hee-Joon; Han, Moon-Ku; Kang, Dong-Wha; Oh, Mi-Sun; Yu, Kyung-Ho

    2012-01-01

    Background and Purpose Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea. Methods The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to f...

  9. Abnormal EEG Complexity and Functional Connectivity of Brain in Patients with Acute Thalamic Ischemic Stroke

    Science.gov (United States)

    Liu, Shuang; Guo, Jie; Meng, Jiayuan; Wang, Zhijun; Yao, Yang; Yang, Jiajia; Qi, Hongzhi; Ming, Dong

    2016-01-01

    Ischemic thalamus stroke has become a serious cardiovascular and cerebral disease in recent years. To date the existing researches mostly concentrated on the power spectral density (PSD) in several frequency bands. In this paper, we investigated the nonlinear features of EEG and brain functional connectivity in patients with acute thalamic ischemic stroke and healthy subjects. Electroencephalography (EEG) in resting condition with eyes closed was recorded for 12 stroke patients and 11 healthy subjects as control group. Lempel-Ziv complexity (LZC), Sample Entropy (SampEn), and brain network using partial directed coherence (PDC) were calculated for feature extraction. Results showed that patients had increased mean LZC and SampEn than the controls, which implied the stroke group has higher EEG complexity. For the brain network, the stroke group displayed a trend of weaker cortical connectivity, which suggests a functional impairment of information transmission in cortical connections in stroke patients. These findings suggest that nonlinear analysis and brain network could provide essential information for better understanding the brain dysfunction in the stroke and assisting monitoring or prognostication of stroke evolution. PMID:27403202

  10. Abnormal EEG Complexity and Functional Connectivity of Brain in Patients with Acute Thalamic Ischemic Stroke

    Science.gov (United States)

    Liu, Shuang; Guo, Jie; Meng, Jiayuan; Wang, Zhijun; Yao, Yang; Yang, Jiajia; Qi, Hongzhi; Ming, Dong

    2016-01-01

    Ischemic thalamus stroke has become a serious cardiovascular and cerebral disease in recent years. To date the existing researches mostly concentrated on the power spectral density (PSD) in several frequency bands. In this paper, we investigated the nonlinear features of EEG and brain functional connectivity in patients with acute thalamic ischemic stroke and healthy subjects. Electroencephalography (EEG) in resting condition with eyes closed was recorded for 12 stroke patients and 11 healthy subjects as control group. Lempel-Ziv complexity (LZC), Sample Entropy (SampEn), and brain network using partial directed coherence (PDC) were calculated for feature extraction. Results showed that patients had increased mean LZC and SampEn than the controls, which implied the stroke group has higher EEG complexity. For the brain network, the stroke group displayed a trend of weaker cortical connectivity, which suggests a functional impairment of information transmission in cortical connections in stroke patients. These findings suggest that nonlinear analysis and brain network could provide essential information for better understanding the brain dysfunction in the stroke and assisting monitoring or prognostication of stroke evolution.

  11. Efficacy of minocycline in acute ischemic stroke: A single-blinded, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastava

    2012-01-01

    Full Text Available Background: Minocycline is a semisynthetic derivative of the tetracycline group of antibiotics, which have neuroprotective effects. In animal stroke models, minocycline had shown promising evidence to improve clinical and functional outcomes. Objective: To analyze the effect of oral minocycline in acute ischemic stroke patients. Materials and Methods: This was a randomized single-blinded open-label study. The study group received oral minocycline 200 mg/day for 5 days and the control group received oral vitamin B capsules. Baseline assessment included the following: National Institute of Health Stroke Scale (NIHSS score, modified Barthel Index (mBI, modified Rankin Scale (mRS score, Magnetic Resonance Imaging (MRI of brain including Diffusion Weighted Imaging (DWI, chest X-ray, and routine laboratory investigations. The clinical scales were repeated at days 1, 7, and 30. The end point was outcomes at 3 months (90 days. Statistical analysis was done with SPSS 11.5 (P<0.05. Paired t-test and multiple-measures Analysis Of Variance (ANOVA were used. Results: Fifty patients with acute ischemic stroke were included in the study. Of these, 23 patients received minocycline and 27 patients received placebo i.e., vitamin B capsules. NIHSS score in patients receiving minocycline had shown statistically significant improvement at day 30 and 90 as compared with the controls. Similarly, mRS scores and BI showed significant improvement in patients receiving minocycline at three months as compared to the control group. No mortality, myocardial infarctions, recurrent strokes, and hemorrhagic transformations were noted in both groups. Conclusions: Patients with acute ischemic stroke had significantly better outcome with minocycline treatment as compared with those administered placebo. The above findings suggest that minocycline can be helpful in reducing the clinical deficits after acute ischemic stroke.

  12. Stroke

    Science.gov (United States)

    ... emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds ... blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused ...

  13. Risk factors for medical complications of acute hemorrhagic stroke

    Institute of Scientific and Technical Information of China (English)

    Jangala Mohan Sidhartha; Aravinda Reddy Purma; Nagaswaram Krupa Sagar; Marri Prabhu Teja; Meda Venkata subbaiah; Muniswami Purushothaman

    2015-01-01

    Objective: To assess the risk factors leading to medical complications of hemorrhagic stroke. Methods: We conducted an observational study in neurology, emergency and general medicine wards at a tertiary care teaching hospital in Kadapa. We recruited hemorrhagic stroke patients, and excluded the patients have evidence of trauma or brain tumor as the cause of hemorrhage. We observed the subjects throughout their hospital stay to assess the risk factors and complications. Results: During period of 12 months, 288 subjects included in the study, 89% of them identified at least 1 prespecified risk factor for their admission in hospital and 75% of them experienced at least 1 prespecified complication during their stay in hospital. Around 47% of subjects deceased, among which 64% were females. Conclusions: Our study has assessed that hypertension followed by diabetes mellitus are the major risk factors for medical complications of hemorrhagic stroke. Female mortality rate was more when compared to males.

  14. MR-visible brain water content in human acute stroke

    DEFF Research Database (Denmark)

    Gideon, P; Rosenbaum, S; Sperling, B;

    1999-01-01

    CBF) SPECT-scanning using 99mTc-HMPAO as flow tracer was performed in the patients. Mean water content (SD) in the infarct area was 37.7 (5.1); 41.8 (4.8); 35.2 (5.4); and 39.3 (5.1) mol x [kg wet weight](-1) at 0-3; 4-7; 8-21; and >180 days after stroke, respectively. Water content increased between Day 0......CBF from Day 0-3 to Day 4-7 (p = 0.050) and from Day 0-3 to Day 8-21 (p = 0.028). No correlation between rCBF and water content was found. Water content in ischemic brain tissue increased significantly between Day 4-7 after stroke. This should be considered when performing quantitative 1H-MRS using water...... as an internal standard in stroke patients....

  15. Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues.

    Science.gov (United States)

    Rosa, Margherita; De Lucia, Silvana; Rinaldi, Victoria Elisa; Le Gal, Julie; Desmarest, Marie; Veropalumbo, Claudio; Romanello, Silvia; Titomanlio, Luigi

    2015-01-01

    Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.

  16. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  17. Post-stroke apathy and hypersomnia lead to worse outcomes from acute rehabilitation.

    Science.gov (United States)

    Harris, Ari L; Elder, Jessica; Schiff, Nicholas D; Victor, Jonathan D; Goldfine, Andrew M

    2014-04-01

    Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. We used multiple regression analysis to control for overall impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic). Forty-four (21%) of the patients had persistent apathy, and 12 (5.6%) had persistent hypersomnia. Both groups were more impaired in cognition, sustained attention, and more likely to be treated for depression. Patients with apathy were 2.4 times more likely to go to a nursing home, and had discharge FIM scores 12 points below the mean. Patients with hypersomnia were ten times more likely to go to a nursing home, and had discharge FIM scores 16 points below the mean. These findings indicate that studies to prospectively define these clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions.

  18. Thrombolytic treatment for acute ischemic cerebral stroke: intraarterial urokinase infusion vs. intravenous heparin and urokinase infusion

    International Nuclear Information System (INIS)

    To evaluate the efficacy and limitation of intra-arterial urokinase (IAUK) infusion for treatment of acute cerebral stroke. Twenty-seven acute cerebral stroke patients treated with IAUK infusion within six hours of stroke onset were reviewed. All patients showed normal initial brain findings on CT. In 21 patients, urokinase(5-15 x 105IU) was administered through a microcatheter placed into or proximal to occluded segment. Mechanical disruption of thrombus by guidewire was performed in 17 patients. Angiographic and clinical responses and complications after IAUK infusion, were evaluated and the results were compared with those of intravenous heparin(N=19) and urokinase infusion(N=19). Complete or partial angiographic recanalization of occluded segment was found in 18 patients (67%), and neurologic improvement was followed in 14 patients(52%). The degree of improvement on the stroke scale score after IAUK infusion was statistically more significant(p<0.05) than that shown after intravenous heparin and urokinase infusion. Complications after IAUK infusion were large(15%) and small amount intracerebral hemorrhage(15%), contrast leakage into brain parenchyma(11%), and gastrointestinal bleeding(4%). Between the IAVK and the intravenous urokinase infusion group, differences in extent and types of complications were statistically insignificant, but were significantly higher in those two groups than in the intravenous heparin infusion group. IAUK infusion may be effective for the treatment of acute cerebral stroke

  19. Clinical impact of MRI perfusion disturbances and normal diffusion in acute stroke patients

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D. [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Seitz, R.J. [Department of Neurology, University Hospital Duesseldorf (Germany); Biomedical Research Centre, Heinrich-Heine-Universitaet Duesseldorf (Germany); Brain Imaging Centre, Research Centre Julich (Germany); Rusch, O.; Janssen, H.; Andersen, K.; Wittsack, H.-J.; Turowski, B. [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)

    2009-07-15

    Purpose: In acute ischemic stroke MR-imaging typically shows diffusion abnormalities surrounded by reduced perfusion signifying the so-called ischemic penumbra. Mismatch between diffusion and perfusion abnormalities gives indication for thrombolysis. But is there an indication for thrombolytic treatment, if there is no diffusion abnormality but pathologic perfusion combined with acute stroke symptoms?. Material and methods: MR-imaging of 1465 patients treated on our Stroke Unit between June 2004 and May 2007 retrospectively are analyzed. 6 patients met the inclusion criteria of severe neurological symptoms, large territorial perfusion disturbances, lack of diffusion abnormalities and complete neurological recovery after treatment. Results: In all six patients MTT measurements showed a significantly depressed perfusion in the symptomatic hemisphere (p < 0.02). Time-to-peak delay correlated with the mean transit time delay (0.949, p < 0.01). Indication for thrombolysis was based on perfusion abnormalities and clinical symptoms. Stroke symptoms could be reversed in all patients without any complication. Conclusion: Whereas diffusion imaging could not reveal any abnormality, perfusion analysis legitimated therapy with systemic thrombolysis in heavily affected patients. This work underlines the importance of multimodal MR imaging for guiding treatment decisions in acute stroke patients.

  20. Effectiveness of Thrombolytic Therapy in Acute Embolic Stroke due to Infective Endocarditis

    OpenAIRE

    Sontineni, Siva P.; Mooss, Aryan N.; Andukuri, Venkata G.; Susan Marie Schima; Dennis Esterbrooks

    2009-01-01

    Objective. To identify the role of thrombolytic therapy in acute embolic stroke due to infective endocarditis. Design. Case report. Setting. University hospital. Patient. A 70-year-old male presented with acute onset aphasia and hemiparesis due to infective endocarditis. His head computerized tomographic scan revealed left parietal sulcal effacement. He was given intravenous tissue plasminogen activator with significant resolution of the neurologic deficits without complications. Main Outcome...

  1. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke

    OpenAIRE

    Guo, Gang; Yang, Yonggui; Yang, Weiqun

    2012-01-01

    We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on ...

  2. Functional Cluster Analysis of CT Perfusion Maps: A New Tool for Diagnosis of Acute Stroke?

    OpenAIRE

    Baumgartner, Christian; Gautsch, Kurt; Böhm, Christian; Felber, Stephan

    2005-01-01

    CT perfusion imaging constitutes an important contribution to the early diagnosis of acute stroke. Cerebral blood flow (CBF), cerebral blood volume (CBV) and time-to-peak (TTP) maps are used to estimate the severity of cerebral damage after acute ischemia. We introduce functional cluster analysis as a new tool to evaluate CT perfusion in order to identify normal brain, ischemic tissue and large vessels. CBF, CBV and TTP maps represent the basis for cluster analysis applying a partitioning (k-...

  3. Use of escitalopram to prevent depression and cognitive impairments in the acute phase of stroke

    Directory of Open Access Journals (Sweden)

    Dina Rustemovna Khasanova

    2013-01-01

    Full Text Available The purpose of the study was to comparatively analyze the rate of post-stroke depression and cognitive impairments in escitalopram (cipralex-treated and untreated (control patients. Emotional and affective cognitive symptoms, neurological deficit, and day-to-day activity were evaluated over time 1, 3, and 6 months after treatment. The results of the study indicated that escitalopram used to prevent depression in the acute phase of stroke provided a good effect. This drug caused a prompter recovery of cognitive impairments and reduced the pace of development of neurodegenerative disorders underlying the post-stroke 2D (depression and dementia syndrome. The study group was recorded to have more favorable functional outcomes of stroke and patient mobility indicators associated with lower disability rates.

  4. The cost of first-ever stroke in Valle d’Aosta, Italy: linking clinical registries and administrative data

    Directory of Open Access Journals (Sweden)

    Bottacchi Edo

    2012-10-01

    Full Text Available Abstract Background Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies. Methods We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis. Results The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5% were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively showed that majority of costs are concentrated in the first months after the acute event. Conclusions This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and

  5. Early rehabilitation and neuroprotective drug therapy outcomes in elderly patients with acute stroke

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Feixue Zhou; Chunlan Cui; Shichao Liu

    2011-01-01

    Sixty elderly patients, who suffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 (75%) of the patients exhibited cognitive impairment to varying degrees, and 25 (45%) of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 (20%) required intermittent supervision, and 20 (36%) required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.

  6. Acute phase IL-10 plasma concentration associates with the high risk sources of cardiogenic stroke.

    Directory of Open Access Journals (Sweden)

    Otso Arponen

    Full Text Available Etiological assessment of stroke is essential for accurate treatment decisions and for secondary prevention of recurrence. There is evidence that interleukin-10 (IL-10 associates with ischemic stroke. The aim of this prospective study was to assess the levels of IL-10 in ischemic stroke with unknown or suspected cardiogenic etiology, and evaluate the correlation between IL-10 plasma concentration and the number of diagnosed high risk sources for cardioembolism.A total of 141 patients (97 males; mean age 61±11 years with acute ischemic stroke with unknown etiology or suspected cardiogenic etiology other than known atrial fibrillation (AF underwent imaging investigations to assess high risk sources for cardioembolic stroke established by the European Association of Echocardiography (EAE. IL-10 was measured on admission to the hospital and on a three month follow-up visit.Acute phase IL-10 concentration was higher in patients with EAE high risk sources, and correlated with their number (p<0.01. In patients with no risk sources (n = 104, the mean IL-10 concentration was 2.7±3.1 ng/L (range 0.3-16.3 ng/L, with one risk source (n = 26 3.7±5.5 ng/L (0.3-23.6 ng/L, with two risk sources (n = 10 7.0±10.0 ng/L (1.29-34.8 ng/L and with three risk sources (n = 1 37.2 ng/L. IL-10 level was not significantly associated with cerebral infarct volume, presence of previous or recent myocardial infarction, carotid/vertebral artery atherosclerosis, paroxysmal AF registered on 24-hour ECG Holter monitoring or given intravenous thrombolytic treatment.IL-10 plasma concentration correlates independently with the number of EAE cardioembolic risk sources in patients with acute stroke. IL-10 may have potential to improve differential diagnostics of stroke with unknown etiology.

  7. Recombinant Human Erythropoietin in the Treatment of Acute Ischemic Stroke

    NARCIS (Netherlands)

    Ehrenreich, Hannelore; Weissenborn, Karin; Prange, Hilmar; Schneider, Dietmar; Weimar, Christian; Wartenberg, Katja; Schellinger, Peter D.; Bohn, Matthias; Becker, Harald; Wegrzyn, Martin; Jaehnig, Peter; Herrmann, Manfred; Knauth, Michael; Baehr, Mathias; Heide, Wolfgang; Wagner, Armin; Schwab, Stefan; Reichmann, Heinz; Schwendemann, Guenther; Dengler, Reinhard; Kastrup, Andreas; Bartels, Claudia

    2009-01-01

    Background and Purpose-Numerous preclinical findings and a clinical pilot study suggest that recombinant human erythropoietin (EPO) provides neuroprotection that may be beneficial for the treatment of patients with ischemic stroke. Although EPO has been considered to be a safe and well-tolerated dru

  8. Cerebral blood flow in acute and chronic ischemic stroke using xenon-133 inhalation tomography

    DEFF Research Database (Denmark)

    Vorstrup, S; Paulson, O B; Lassen, N A

    1986-01-01

    Serial measurements of cerebral blood flow (CBF) were performed in 12 patients with acute symptoms of ischemic cerebrovascular disease. CBF was measured by xenon-133 inhalation and single photon emission computer tomography. Six patients had severe strokes and large infarcts on the CT scan. They...

  9. Development and validation of intracranial thrombus segmentation on CT angiography in patients with acute ischemic stroke

    NARCIS (Netherlands)

    E.M.M. Santos (Emilie M.); H. Marquering (Henk); O.A. Berkhemer (Olvert); W.H. van Zwam (Wim); A. van der Lugt (Aad); C.B. Majoie (Charles); W.J. Niessen (Wiro)

    2014-01-01

    textabstractBackground and Purpose: Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and tim

  10. Risk of Acute Myocardial Infarction or Stroke in Patients with Mycosis Fungoides and Parapsoriasis

    DEFF Research Database (Denmark)

    Lindahl, Lise Maria; Heide-Jørgensen, Uffe; Pedersen, Lars;

    2015-01-01

    Mycosis fungoides (MF) and parapsoriasis display increased inflammation, which may be associated with increased risk of arterial cardiovascular events. The aim of this Danish nationwide population-based cohort study was to assess the relative risk (RR) of acute myocardial infarction (AMI) or stroke...

  11. Is visuospatial hemineglect really a determinant of postural control following stroke? An acute-phase study.

    NARCIS (Netherlands)

    Nes, I.J.W. van; Linden, S. van der; Hendricks, H.T.; Kuijk, A.A. van; Rulkens, M.; Verhagen, W.I.; Geurts, A.C.H.

    2009-01-01

    OBJECTIVE: The purpose of this study was to determine the independent contribution of visuospatial hemineglect to impaired postural control in the acute phase (<2 weeks) of stroke compared with other possible clinical and biological determinants. METHODS: This study was conducted in 4 hospitals i

  12. ”Missing clot” during mechanical thrombectomy in acute stroke using Solitaire stent retrieval system

    Directory of Open Access Journals (Sweden)

    Vikram Huded

    2016-01-01

    Full Text Available Stent retrieval system is an established treatment modality in acute ischemic stroke with large vessel occlusion. Here, we describe a complication which occurred during mechanical thrombectomy in three cases where the clot dislodged during retrieval. There was a possibility of the clot getting reinjected into the artery with possible dire consequences.

  13. Acute hemorrhagic stroke in young adults-a study in a tertiary-care hospital of North India

    OpenAIRE

    Baidya, Omkar Prasad; Tiwari, Sunita; Usman, Kauser

    2015-01-01

    Objectives: To see the risk factors, clinical presentations and radiological profile of acute hemorrhagic stroke in young subjects in a tertiary-care hospital of North India.Methods: This study was carried out among 50 acute hemorrhagic stroke patients (clinically and radiologically confirmed) irrespective of sex within the age group of 15-45 years admitted to Department of Medicine after getting clearance from Institutional Ethical Committee (IEC). A proforma for each of the acute hemorrhagi...

  14. Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Rajeev K., E-mail: rajeev.verma@insel.ch [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Hsieh, Kety; Gratz, Pascal P.; Schankath, Adrian C.; Mordasini, Pasquale; Zubler, Christoph; Kellner-Weldon, Frauke [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Jung, Simon [Department of Neurology, Inselspital, University of Bern, Bern (Switzerland); Schroth, Gerhard; Gralla, Jan; El-Koussy, Marwan [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland)

    2014-08-15

    Background: The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings. Methods: 33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented. Results: 20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p = 0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p < 0.00). Conclusions: In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill

  15. Stroke severity and incidence of acute large vessel occlusions in patients with hyper-acute cerebral ischemia

    DEFF Research Database (Denmark)

    Hansen, Christine Kraup; Christensen, Anders Fogh; Ovesen, C;

    2015-01-01

    BACKGROUND: The frequency of acute large vessel occlusions in relation to clinical severity has not yet been established in a comprehensive, consecutive and unselected cohort of patients with hyper-acute cerebral ischemia. AIM: The aim of this study was to establish the frequency of acute large...... vessel occlusions and describe the relations to the National Institutes of Health Stroke Scale (NIHSS), lesion site and time from symptom onset in unselected consecutive patients with hyper-acute cerebral ischemia. METHODS: A prospective single hospital registry was based on consecutive unselected...... patients admitted from July 2009 to December 2011 with symptoms of acute cerebral ischemia within 4.5 h from symptom onset. ICA, M1, M2, ACA, PCA, BA and VA were assed for occlusions. Best NIHSS-cut-off values were calculated based on sensitivity and specificity for detecting any, anterior and posterior...

  16. Solar term peak of onset and death in 1597 patients with acute ischemic stroke Circular statistical analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Previously, time data were analyzed by using constituent ratio or relative ratio; however,circular statistical analysis could exactly provide average peak phase of diseases.OBJECTIVE: To investigate the correlation of solar term peak with onset and death of acute ischemic stroke.DESIGN: Retrospective case analysis.SETTINGS: Emergency Department of Foshan Municipal Hospital of Traditional Chinese Medicine;Department of Science and Education, the Second People's Hospital of Foshan.PARTICIPANTS: A total of 1597 patients with acute ischemic stroke were selected from Emergency Room,Department of Neurology, Foshan Municipal Hospital of Traditional Chinese Medicine from 1994 to 2002.There were 875 males and 722 females, and their ages ranged from 33 to 97 years. All cases met the diagnostic criteria of acute cerebral infarction modified by the Second National Cerebrovascular Disease Academic Meeting; meanwhile, they were diagnosed with CT/MRI test. Patients and their relatives provided the confirmed consent.METHODS: Solar term of onset was retrospectively analyzed in 1 597 patients with acute ischemic stroke;among them, solar term of death in 90 cases were analyzed by using circular statistical analysis to calculate peak phase of onset and death of acute ischemic stroke and investigate the correlation of solar term with onset and death of acute ischemic stroke.MAIN OUTCOME MEASURES: Onset and death time of patients with acute ischemic stroke. RESULTS: Solar term of onset in 1 597 patients, especially solar term of death in 90 patients, was not concentrated (P > 0.05), and specific peak phase was not found out. Acute ischemic stroke low attacked from vernal equinox to summer begins, but death caused by acute ischemic stroke high attacked from grain buds to autumn begins.CONCLUSION: Patients with acute ischemic stroke do not have specific solar term peak of onset and death.

  17. High Homocysteine and Blood Pressure Related to Poor Outcome of Acute Ischemia Stroke in Chinese Population

    Science.gov (United States)

    Liu, Changjiang; Zhao, Liang; Zhou, Mo; Sun, Wenjie; Xu, Tan; Tong, Weijun

    2014-01-01

    Objectives To assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population. Methods Between June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models. Results Compared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend  = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19–1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85–1.53), 1.37 (1.03–1.84) and 1.70 (1.29–2.34), respectively. Conclusion The present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility

  18. Reasons for diagnostic delay in patient with out-of-hospital acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Tongge Wang; Qi Ma

    2006-01-01

    BACKGROUND:Time window is a common problem in various therapies of acute ischemic stroke,and diagnostic duration plays an important role in prognosis.OBJECTIVE:To analyze the main reasons for out-of-hospital diagnostic delay of patients with acute ischemic stroke.DESIGN:Survey and analysis.SETTING:Department of Neurology,the First Affiliated Hospital of Jinan University.PARTICIPANTS: A total of 116 patients with acute ischemic stroke were selected from the Department of Neurology,the First Affiliated Hospital of Jinan University from December 2002 to December 2005,including 79 males and 37 females aged fnom 35 to 90 years with the mean age of(65+10)years.All patients met the diagnostic criteda of "mainly diagnostic points of various cerebrovascular diseases"established by the 4th National Cerebrovascular Diseases Meeting in 1995.Patients having acute ischemic stroke in hospital were excluded.Moreover,32 nurses received questionnaires of partial items.All patients and nurses provided informed consent.METHODS:①Information,such as social Position,educational level and incomes,was added up based on questionnaires.②Out-of-hospital diagnostic delay was surveyed based on the recorded time of patients treated in emergency department and out-patient clinic or during hospitalization. ③Ability of patients and nurses to identify symptoms of stroke dudng an early period was evaluated:meanwhile,understanding concept of stroke and using emergent system of social medicine by patients were surveyed,Especially.whether Patients understood the emergent number"120" or not and how they used it practically were investigated further.④Attitude and behavior of patients to stroke were surveyed.⑤Whether patients were able to identify the symptoms of stroke or not was investigated;furthermore,identification of stroke by patients and nurses was dealt with semi-quantitative analysis.The scores ranged from-10 to 10.The higher the scores were,the better the identification was

  19. Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever.

    Science.gov (United States)

    Savastano, Luis; Gemmete, Joseph J; Pandey, Aditya S; Roark, Christopher; Chaudhary, Neeraj

    2016-08-01

    Ischemic strokes in childhood are rare. Thrombolytic therapy with intravenous (IV) tissue plasminogen activator (tPA) has been the main intervention for the management of pediatric stroke patients, but safety data are lacking and efficacy has been questioned. Recently, successful endovascular treatments for acute ischemic stroke in children have been reported with increasing frequency, suggesting that mechanical thrombectomy can be a safe and effective treatment. We present the case of a 22-month-old child with acute ischemic stroke due to basilar artery occlusion that was successfully treated with a stent retriever. PMID:26156170

  20. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Madsen, Tracy E.

    2014-12-01

    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  1. Logical Analysis of Data (LAD model for the early diagnosis of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hoehn Gerard

    2008-07-01

    Full Text Available Abstract Background Strokes are a leading cause of morbidity and the first cause of adult disability in the United States. Currently, no biomarkers are being used clinically to diagnose acute ischemic stroke. A diagnostic test using a blood sample from a patient would potentially be beneficial in treating the disease. Results A classification approach is described for differentiating between proteomic samples of stroke patients and controls, and a second novel predictive model is developed for predicting the severity of stroke as measured by the National Institutes of Health Stroke Scale (NIHSS. The models were constructed by applying the Logical Analysis of Data (LAD methodology to the mass peak profiles of 48 stroke patients and 32 controls. The classification model was shown to have an accuracy of 75% when tested on an independent validation set of 35 stroke patients and 25 controls, while the predictive model exhibited superior performance when compared to alternative algorithms. In spite of their high accuracy, both models are extremely simple and were developed using a common set consisting of only 3 peaks. Conclusion We have successfully identified 3 biomarkers that can detect ischemic stroke with an accuracy of 75%. The performance of the classification model on the validation set and on cross-validation does not deteriorate significantly when compared to that on the training set, indicating the robustness of the model. As in the case of the LAD classification model, the results of the predictive model validate the function constructed on our support-set for approximating the severity scores of stroke patients. The correlation and root mean absolute error of the LAD predictive model are consistently superior to those of the other algorithms used (Support vector machines, C4.5 decision trees, Logistic regression and Multilayer perceptron.

  2. MRI in predication of early hemorrhagic transformation after acute stroke

    International Nuclear Information System (INIS)

    Objective: To investigate the relationship among early parenchymal enhancement, post- gadolinium (Gd) hyperintense middle cerebral artery (HMCA), and subsequent hemorrhagic transformation (HT) in patients with hyperacute ischemic stroke. Methods: Twenty-four consecutive patients with ischemic stroke who underwent MRI within 6 h [(4.3±1.4) h] of symptom onset were retrospectively reviewed. All of these patients underwent at least one follow-up MRI or non-enhanced CT study at 2 to 7 days. Post-Gd T1WI were analyzed for parenchymal enhancement and hyperintense MCA. Gradient echo MRI and CT were used for assessment of HT. Results: Ten patients developed HT on follow-up imaging (hemorrhagic group). Early parenchymal enhancement was found in 6 patients with HT (P1WI after Gd-DTPA administration are independent predictors of subsequent HT. (authors)

  3. Ischaemic heart disease

    DEFF Research Database (Denmark)

    Hansen, Louise Houlberg; Mikkelsen, Søren

    2013-01-01

    Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD) may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU) in Odense, Denmark...

  4. Occult infarct with acute hemorrhagic stroke in juvenile diabetic ketoacidosis.

    Science.gov (United States)

    Lin, Jainn-Jim; Lin, Kuang-Lin; Wang, Huei-Shyong; Wong, Alex Mun-Ching; Hsia, Shao-Hsuan

    2008-01-01

    Diabetes ketoacidosis (DKA) is one of the common complications of type I insulin-dependent diabetes mellitus. Neurological deterioration during an episode of DKA is usually assumed to be caused by cerebral edema and cerebral vascular accidents. However, hemorrhagic stroke is a very rare complication of juvenile DKA. We describe a girl who had newly diagnosed insulin-dependent diabetes mellitus with juvenile DKA developed intracerebral hemorrhage. PMID:17629647

  5. Update on acute endovascular and surgical stroke treatment

    DEFF Research Database (Denmark)

    Kondziella, D; Cortsen, M; Eskesen, V;

    2013-01-01

    Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical...... thrombectomy and angioplasty/stenting, is under rapid development. Although EVT has yet to be shown in randomized controlled trials to improve clinical outcome compared to intravenous thrombolysis, it is far better in achieving recanalization of occluded large cerebral vessels, which is crucial for rescuing...

  6. The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K; Korsholm, Lars; Høilund-Carlsen, Poul Flemming;

    2007-01-01

    in patients with an acute ischemic stroke exists. METHODS: Serial measurements of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 12-lead ECGs were obtained in 192 consecutive patients with an acute ischemic stroke without ischemic heart disease, atrial fibrillation, heart- or renal failure......-T changes in the ECG remained associated with increased levels of NT-proBNP (beta=76.5, p=0.011). CONCLUSIONS: ST-T changes suggestive of myocardial ischemia are independently associated with the levels of NT-proBNP in patients with acute ischemic stroke. The clinical importance of this observation remains...

  7. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sana Zaheer

    2013-01-01

    Full Text Available Context: The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE, which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker. Aims: This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30. Materials and Methods: Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA. Volume of infarct was measured by computed tomography (CT scan using the preinstalled software Syngo (version A40A of Siemen′s medical solutions (Forchheim, Germany. Stroke severity at admission was assessed using Glasgow coma scale (GCS and functional neurological outcome was assessed using modified Rankin scale (mRS on day 30. Statistical Analysis Used: Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS. Results: A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P < 0.001. A strong negative correlation was found between GCS at presentation and concentration of NSE on day 1 (r = −0.806, P < 0.001. There was a positive correlation between NSE levels at day 1 and functional neurological outcome assessed by mRS at day 30 (r = 0.744, P < 0.001. Conclusions: Serum levels of NSE in first few days of ischemic stroke can serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.

  8. The Assessment of Early Stage Computed Tomography Findings in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Nebahat Taşdemir

    2008-01-01

    Full Text Available The imaging techniques have become important tools during diagnostic stage of acute ischemic stroke during the last 30 years. The improvement in these techniques further increased the clinical areas that these tools could be used. As computerized brain tomography (CT is a rapid, cheap, non-invasive and highly available imaging tool in most hospitals, it remains to be the primary scanning method for all acute patients.The aim of this study was to evaluate the early stage CT findings in the ischemic stroke patients which have been scanned in the first 8 to 12 hours after the incidence. Sixty four cases (26 male, 38 female who had clinical symptoms of ischemic stroke have been included in this study. CT scan was performed twice to these patients; first in the first 8 to 12 hours, and second in between 24 hours and 48 hours after the stroke. The middle cerebral artery perfused area was the most common arterial area affected among cases who had CT findings in early scans. Hypodense lesions were most common lesions encountered in CT findings. Hyperdense middle cerebral artery sign in early CT findings could be an indicator of ischemia due to arterial occlusion. We determined that the CT images obtained at the beginning of developing stroke appeared to show the lesions smaller than what they really were. There were significant differences between the emergency room evaluation and detailed clinical evaluation of CT scans. More findings have been observed in late CT scans performed between 24 hours and 48 hours than the ones performed in the first 8 hours and 12 hours. There was no correlation between the presence of CT findings in early scans and severity of clinical features of ischemia. CT appears to be an important tool in diagnosing ischemic strokes even at early stages. Developments in diagnostic precision of CT tools will further increase our understanding of ischemic strokes and their clinical progress.

  9. Evaluating effects of normobaric oxygen therapy in acute stroke with MRI-based predictive models

    Directory of Open Access Journals (Sweden)

    Wu Ona

    2012-03-01

    Full Text Available Abstract Background Voxel-based algorithms using acute multiparametric-MRI data have been shown to accurately predict tissue outcome after stroke. We explored the potential of MRI-based predictive algorithms to objectively assess the effects of normobaric oxygen therapy (NBO, an investigational stroke treatment, using data from a pilot study of NBO in acute stroke. Methods The pilot study of NBO enrolled 11 patients randomized to NBO administered for 8 hours, and 8 Control patients who received room-air. Serial MRIs were obtained at admission, during gas therapy, post-therapy, and pre-discharge. Diffusion/perfusion MRI data acquired at admission (pre-therapy was used in generalized linear models to predict the risk of lesion growth at subsequent time points for both treatment scenarios: NBO or Control. Results Lesion volume sizes 'during NBO therapy' predicted by Control-models were significantly larger (P = 0.007 than those predicted by NBO models, suggesting that ischemic lesion growth is attenuated during NBO treatment. No significant difference was found between the predicted lesion volumes at later time-points. NBO-treated patients, despite showing larger lesion volumes on Control-models than NBO-models, tended to have reduced lesion growth. Conclusions This study shows that NBO has therapeutic potential in acute ischemic stroke, and demonstrates the feasibility of using MRI-based algorithms to evaluate novel treatments in early-phase clinical trials.

  10. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

    Directory of Open Access Journals (Sweden)

    Josie Merchant

    2016-01-01

    Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

  11. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction.

    Directory of Open Access Journals (Sweden)

    Siamak Abdi

    2015-03-01

    Full Text Available Serum troponin elevation, characteristic of ischemic myocardial injury, has been observed in some acute ischemic stroke (AIS patients. Its cause and significance are still controversial. The purpose of this study is to find determinants of troponin elevation and its relationship with stroke severity and location.Between January 2013 and August 2013, 114 consecutive AIS patients confirmed by diffusion-weighted magnetic resonance imaging were recruited in this study. Serum troponin T level was measured as part of routine laboratory testing on admission. Ten lead standard electrocardiogram (ECG was performed and stoke severity was assessed based on National Institutes of Health Stroke Scale (NIHSS.Troponin T was elevated in 20 (17.6% of 114 patients. Patients with elevated troponin were more likely to have higher age, higher serum creatinine and ischemic ECG changes. Troponin levels were higher in patients with more severe stroke measured by NIHSS [7.96 (6.49-9.78 vs. 13.59 (10.28-18.00]. There was no association between troponin and locations of stroke and atrial fibrillation. There were 6 (5% patients with elevated troponin in the presence of normal creatinine and ECG.Stroke severity, not its location, was associated with higher troponin levels. Abnormal troponin levels are more likely, but not exclusively, to be due to cardiac and renal causes than cerebral ones.

  12. Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Sørensen, Sigrid B; Barazangi, Nobl; Chen, Charlene;

    2016-01-01

    BACKGROUND: Common intravenous recombinant tissue plasminogen activator (IV rt-PA) exclusion criteria may substantially limit the use of thrombolysis. Preliminary data have shown that the SMART (Simplified Management of Acute stroke using Revised Treatment) criteria greatly expand patient...... eligibility by reducing thrombolysis exclusions, but they have not been assessed on a large scale. We evaluated the safety and efficacy of general adoption of SMART thrombolysis criteria to a large regional stroke network. METHODS: Retrospective analysis of consecutive patients who received IV thrombolysis...... application of SMART criteria is safe and effective. Widespread application of these criteria could substantially increase the proportion of patients who might qualify for treatment....

  13. The L-arginine Pathway in Acute Ischemic Stroke and Severe Carotid Stenosis

    DEFF Research Database (Denmark)

    Molnar, Tihamer; Pusch, Gabriella; Papp, Viktoria;

    2014-01-01

    BACKGROUND: Endothelial dysfunction is associated with increased levels of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) resulting in a decreased production of nitric oxide, which regulates the vascular tone. METHODS: Patients with acute ischemic stroke (AIS, n = 55......) and asymptomatic significant carotid stenosis (AsCS, n = 44) were prospectively investigated. L-arginine, ADMA, SDMA, S100 B, and high-sensitivity C-reactive protein (hsCRP) were serially measured within 6 hours after the onset of stroke, at 24 and 72 poststroke hours. All markers were compared with healthy...

  14. HIGH SENSITIVITY C - REACTIVE PROTEIN AS A PROGNOSTIC MARKER IN ACUTE STROKE

    OpenAIRE

    Jayachandra; Mamatha; Veeranna Gowda; Sowrabha Shankar; Raghavendra; Yashavanth

    2014-01-01

    OBJECTIVES: To determine raised serum hsCRP levels, an established risk marker in stroke patients and also to study the co relation between raised serum uric acid and hsCRP levels in ischemic and hemorrhagic stroke. MATERIALS AND METHODS: This was a cross sectional study of 200 patients presenting with a history of focal neurological deficit of acute onset in the form of hemiparesis, hemiplegia having evidence of presence of ischemic or hemorrhagic infarct in CT scan of brain. In all patients...

  15. Head movement during CT brain perfusion acquisition of patients with suspected acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Fahmi, F., E-mail: f.fahmi@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Beenen, L.F.M., E-mail: l.f.beenen@amc.uva.nl [Department of Radiology, AMC, Amsterdam (Netherlands); Streekstra, G.J., E-mail: g.j.streekstra@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Janssen, N.Y., E-mail: n.n.janssen@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Jong, H.W. de, E-mail: H.W.A.M.deJong@umcutrecht.nl [Department of Radiology, UMC Utrecht, 3584CX, Utrecht (Netherlands); Riordan, A., E-mail: alan.riordan@gmail.com [Department of Radiology, UMC Utrecht, 3584CX, Utrecht (Netherlands); Roos, Y.B., E-mail: y.b.roos@amc.uva.nl [Department of Neurology, AMC, Amsterdam (Netherlands); Majoie, C.B., E-mail: c.b.majoie@amc.uva.nl [Department of Radiology, AMC, Amsterdam (Netherlands); Bavel, E. van, E-mail: e.vanbavel@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Marquering, H.A., E-mail: h.a.marquering@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Department of Radiology, AMC, Amsterdam (Netherlands)

    2013-12-01

    Objective: Computed Tomography Perfusion (CTP) is a promising tool to support treatment decision for acute ischemic stroke patients. However, head movement during acquisition may limit its applicability. Information of the extent of head motion is currently lacking. Our purpose is to qualitatively and quantitatively assess the extent of head movement during acquisition. Methods: From 103 consecutive patients admitted with suspicion of acute ischemic stroke, head movement in 220 CTP datasets was qualitatively categorized by experts as none, minimal, moderate, or severe. The movement was quantified using 3D registration of CTP volume data with non-contrast CT of the same patient; yielding 6 movement parameters for each time frame. The movement categorization was correlated with National Institutes of Health Stroke Scale (NIHSS) score and baseline characteristic using multinomial logistic regression and student's t-test respectively. Results: Moderate and severe head movement occurred in almost 25% (25/103) of all patients with acute ischemic stroke. The registration technique quantified head movement with mean rotation angle up to 3.6° and 14°, and mean translation up to 9.1 mm and 22.6 mm for datasets classified as moderate and severe respectively. The rotation was predominantly in the axial plane (yaw) and the main translation was in the scan direction. There was no statistically significant association between movement classification and NIHSS score and baseline characteristics. Conclusions: Moderate or severe head movement during CTP acquisition of acute stroke patients is quite common. The presented registration technique can be used to automatically quantify the movement during acquisition, which can assist identification of CTP datasets with excessive head movement.

  16. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Cevik, Ozge; Baykal, Ahmet Tarik; Sener, Azize

    2016-01-01

    Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters) was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org) and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics). These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides an insight into

  17. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Cevik, Ozge; Baykal, Ahmet Tarik; Sener, Azize

    2016-01-01

    Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters) was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org) and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics). These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides an insight into

  18. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Ozge Cevik

    Full Text Available Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics. These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides

  19. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients

    Science.gov (United States)

    Baykal, Ahmet Tarik; Sener, Azize

    2016-01-01

    Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets’ tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters) was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org) and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics). These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides an insight

  20. Efficacy and safety of thrombolysis in patients aged 80 years or above with major acute ischemic stroke

    OpenAIRE

    Sang-Chul Kim; Keun-Sik Hong; Yong-Jin Cho; Joong-Yang Cho; Hee-Kyung Park; Pamela Song

    2012-01-01

    Background: Elderly patients with major ischemic strokes may remain severely disabled or dead. However, efficacy and safety of thrombolysis in this have not been fully explored. Materials and Methods: Data from the case records of patients aged >80 years with acute ischemic stroke with admission National Institute of Health Stroke Scale (NIHSS) score ≥10 admitted between April 2009 and May 2011 were retrieved. Outcomes in patients treated with thrombolysis and control subjects were compared. ...

  1. The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

    OpenAIRE

    Lee, Kyeong Woo; Kim, Sang Beom; Lee, Jong Hwa; Lee, Sook Joung; Ri, Jae Won; Park, Jin Gee

    2014-01-01

    Objective To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS). Methods Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one pat...

  2. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy resulting in stroke in an 11-year-old male

    DEFF Research Database (Denmark)

    Granild-Jensen, Jakob; Jensen, Uffe Birk; Schwartz, Marianne;

    2009-01-01

    or transient ischaemic attacks. We report the case of an 11-year-old male with CADASIL resulting in stroke with right hemiparesis and dysphasia. Acute magnetic resonance imaging suggested infarction in the left hemisphere; magnetic resonance angiography revealed calibre variation of the intracerebral arteries....... The patient suffered from common migraine with five to six attacks per month for 3 years 6 months before the stroke. Attacks occurred early in the morning with severe one-sided headache, photophobia, nausea, and vomiting. Antimigraine medications had no effect. The family history revealed more cases....... Our case report highlights the need for paediatricians to consider CADASIL in childhood stroke as well as in migraine patients....

  3. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

    LENUS (Irish Health Repository)

    2011-04-01

    Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.

  4. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, L; Nygård, A; Ovesen, C;

    2014-01-01

    INTRODUCTION: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments....... The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke...... scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most...

  5. Review of technology development and clinical trials of transcranial laser therapy for acute ischemic stroke treatment

    Science.gov (United States)

    Catanzaro, Brian E.; Streeter, Jackson; de Taboada, Luis

    2010-02-01

    Stroke is the one of the leading causes of mortality in the United States, claiming 600,000 lives each year. Evidence suggests that near infrared (NIR) illumination has a beneficial effect on a variety of cells when these cells are exposed to adverse conditions. Among these conditions is the hypoxic state produced by acute ischemic stroke (AIS). To demonstrate the impact NIR Transcranial Laser Therapy (TLT) has on AIS in humans, a series of double blind, placebo controlled clinical trials were designed using the NeuroThera(R) System (NTS). The NTS was designed and developed to treat subjects non-invasively using 808 nm NIR illumination. TLT, as it applies to stroke therapy, and the NTS will be described. The results of the two clinical trials: NeuroThera(R) Safety and Efficacy Trial 1 (NEST-1) and NeuroThera(R) Safety and Efficacy Trial 2 (NEST-2) will be reviewed and discussed.

  6. Association of deep venous thrombosis with calf vein diameter in acute hemorrhagic stroke.

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

    2013-10-01

    We investigated the association between the development of deep venous thrombosis (DVT) and calf vein diameter in patients with acute hemorrhagic stroke. We measured the maximum diameter of paralytic side posttibial veins (PTVs) and peroneal veins (PVs) in 49 patients with intracerebral hemorrhage on admission and at 2 weeks after stroke onset by ultrasonography. We also examined for the presence or absence of DVT, and then analyzed the association of DVT with the maximum vein diameter. At 2 weeks after stroke, DVTs were detected in PTVs in 7 patients and in PVs in 6 patients. The maximum calf vein diameters at 2 weeks were significantly greater in patients with DVT compared with those without DVT (PTV, P = .033; PV, P = .015). Although calf vein diameter at admission did not influence the future incidence of DVT in patients with intracerebral hemorrhage, the presence of DVT was associated with calf vein dilatation.

  7. Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xu YH

    2016-03-01

    Full Text Available Yan-Hong Xu,1 Xing-De Wang,2 Jia-Jun Yang,1 Li Zhou,2 Yong-Chao Pan1 1Department of Neurology, 2Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background and purpose: Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC and deceleration capacity (DC of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke. Methods: A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD were calculated. The National Institutes of Health Stroke Scale (NIHSS was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores. Results: The R–R (R wave to R wave on electrocardiogram intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043, but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC| and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004. Correlation analysis also showed that DC, |AC|, and SDNN

  8. The Relationship between C-Reactive Protein Level and Discharge Outcome in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Geng, He-Hong; Wang, Xin-Wang; Fu, Rong-Li; Jing, Meng-Juan; Huang, Ling-Ling; Zhang, Qing; Wang, Xiao-Xiao; Wang, Pei-Xi

    2016-01-01

    Previous studies showed that C-reactive protein (CRP), an inflammatory marker, was associated with stroke severity and long-term outcome. However, the relationship between the acute-phase CRP level and discharge outcome has received little attention. We prospectively studied 301 patients with acute ischemic stroke (over a period of two weeks) from two hospital stroke wards and one rehabilitation department in Henan, China. Patients’ demographic and clinical data were collected and evaluated at admission. Poor discharge outcome was assessed in patients at discharge using the Modified Rankin Scale (MRS > 2). Multivariate logistic regression analysis was performed to determine the risk factors of poor discharge outcome after adjusting for potential confounders. Poor discharge outcome was observed in 78 patients (25.9%). Univariate analyses showed that factors significantly influencing poor discharge outcome were age, residence, recurrent acute ischemic stroke, coronary heart disease, the National Institutes of Health Stroke Scale (NIHSS) score at admission, non-lacunar stroke, time from onset of stroke to admission, CRP, TBIL (total bilirubin), direct bilirubin (DBIL), ALB (albumin), FIB (fibrinogen) and D-dimer (p < 0.05). After adjusting for age, residence, recurrent ischemic stroke, coronary heart disease, NIHSS score at admission, lacunar stroke, time from onset of stroke to admission, CRP, TBIL, DBIL, ALB, FIB and D-dimer, multivariate logistic regression analyses revealed that poor outcome at discharge was associated with recurrent acute ischemic stroke (OR, 2.115; 95% CI, 1.094–4.087), non-lacunar stroke (OR, 2.943; 95% CI, 1.436–6.032), DBIL (OR, 1.795; 95% CI, 1.311–2.458), and CRP (OR, 4.890; 95% CI, 3.063–7.808). In conclusion, the CRP level measured at admission was found to be an independent predictor of poor outcome at discharge. Recurrent acute ischemic stroke, non-lacunar stroke and DBIL were also significantly associated with discharge

  9. Safety and efficacy of intensive vs. guideline antiplatelet therapy in high‐risk patients with recent ischemic stroke or transient ischemic attack: rationale and design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial (ISRCTN47823388)

    OpenAIRE

    ,

    2015-01-01

    Rationale The risk of recurrence following a stroke or transient ischemic attack is high, especially immediately after the event. Hypothesis Because two antiplatelet agents are superior to one in patients with non‐cardioembolic events, more intensive treatment might be even more effective. Sample size estimates The sample size of 4100 patients will allow a shift to less recurrence, and less severe recurrence, to be detected (odds ratio 0·68) with 90% power at 5% significance. Methods and desi...

  10. Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit

    Directory of Open Access Journals (Sweden)

    Siegert Richard J

    2006-02-01

    Full Text Available Abstract Background Organised stroke care saves lives and reduces disability. A clinical pathway might be a form of organised stroke care, but the evidence for the effectiveness of this model of care is limited. Methods This study was a retrospective audit study of consecutive stroke admissions in the setting of an acute general medical unit in a district general hospital. The case-notes of patients admitted with stroke for a 6-month period before and after introduction of the pathway, were reviewed to determine data on length of stay, outcome, functional status, (Barthel Index, BI and Modified Rankin Scale, MRS, Oxfordshire Community Stroke Project (OCSP sub-type, use of investigations, specific management issues and secondary prevention strategies. Logistic regression was used to adjust for differences in case-mix. Results N = 77 (prior to the pathway and 76 (following the pathway. The median (interquartile range, IQR age was 78 years (67.75–84.25, 88% were European NZ and 37% were male. The median (IQR BI at admission for the pre-pathway group was less than the post-pathway group: 6 (0–13.5 vs. 10 (4–15.5, p = 0.018 but other baseline variables were statistically similar. There were no significant differences between any of the outcome or process of care variables, except that echocardiograms were done less frequently after the pathway was introduced. A good outcome (MRS Conclusion A clinical pathway for acute stroke management appeared to have no benefit for the outcome or processes of care and may even have been associated with worse outcomes. These data support the conclusions of a recent Cochrane review.

  11. A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Samai, Alyana A.; Boehme, Amelia K.; Shaban, Amir; George, Alexander J.; Dowell, Lauren; Monlezun, Dominique J.; Leissinger, Cindy; Schluter, Laurie; El Khoury, Ramy; Martin-Schild, Sheryl

    2016-01-01

    Background and Purpose Elevated levels of coagulation factor VIII (FVIII) may persist independent of the acute-phase response; however, this relationship has not been investigated relative to acute ischemic stroke (AIS). We examined the frequency and predictors of persistently elevated FVIII in AIS patients. Methods AIS patients admitted between July 2008 and May 2014 with elevated baseline FVIII levels and repeat FVIII levels drawn for more than 7 days postdischarge were included. The patients were dichotomized by repeat FVIII level for univariate analysis at 150% and 200% activity thresholds. An adjusted model was developed to predict the likelihood of persistently elevated FVIII levels. Results Among 1616 AIS cases, 98 patients with elevated baseline FVIII had repeat FVIII levels. Persistent FVIII elevation was found in more than 75% of patients. At the 150% threshold, the prediction score ranged from 0 to 7 and included black race, female sex, prior stroke, hyperlipidemia, smoking, baseline FVIII > 200%, and baseline von Willebrand factor (vWF) level greater than 200%. At the 200% threshold, the prediction score ranged from 0–5 and included female sex, prior stroke, diabetes mellitus, baseline FVIII level greater 200%, and baseline vWF level greater than 200%. For each 1-point increase in score, the odds of persistent FVIII at both the 150% threshold (odds ratio [OR] = 10.4, 95% confidence interval [CI] 1.63–66.9, P = .0134) and 200% threshold (OR = 10.2, 95% CI 1.82–57.5, P = .0083) increased 10 times. Conclusion Because an elevated FVIII level confers increased stroke risk, our model for anticipating a persistently elevated FVIII level may identify patients at high risk for recurrent stroke. FVIII may be a target for secondary stroke prevention. PMID:26777556

  12. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    L. Bentsen

    2014-01-01

    Full Text Available Introduction: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments. The aim of this study was to assess the prevalence of CT angiography (CTA-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke. Method: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most plausible causes of stroke, namely either a possible dissection or a kinked artery. Results: Findings in the extracranial vertebral arteries included significant stenosis (0.8%, atherosclerotic plaque types (3.8%, possible dissections (2.6%, kinked arteries (2.6% and coiling (32.0%. Eighteen patients (2.8% with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5% and 15 cases (2.3% were possible dissections. Conclusion: We found that in approximately 3% of the study population, the most plausible cause of the cryptogenic strokes was due to a pathological finding in the posterior extracranial vertebral arteries, being either a possible

  13. Endovascular Acute Stroke Treatment Performed by Vascular Interventional Radiologists: Is It Safe and Efficacious?

    Energy Technology Data Exchange (ETDEWEB)

    Fjetland, Lars, E-mail: lars.fjetland@lyse.net; Roy, Sumit; Kurz, Kathinka D. [Stavanger University Hospital, Department of Radiology (Norway); Larsen, Jan Petter; Kurz, Martin W. [Stavanger University Hospital, Norwegian Centre for Movement Disorders (Norway)

    2012-10-15

    Purpose: To evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by a team of vascular interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists and to compare the results with those of previous reports from centres with specialised interventional neuroradiologists. Material and Methods: A total of 39 patients with acute ischemic stroke due to large-vessel occlusion not responding to or not eligible for intravenous thrombolysis were treated with either intra-arterial thrombolysis or mechanical thrombectomy (Penumbra System or solitaire FR thrombectomy system, respectively) and included in our prospective study. Outcomes were measured using the modified Rankin scale after 90 days, and recanalization was assessed by thrombolysis using the myocardial infarction score. Results: Mean patient age was 68.3 {+-} 14.2 years; the average National Institutes of Health Stroke Scale score at hospital admission was 17.2 (SD = 6.2 [n = 38]). Successful recanalization was achieved in 74.4 % of patients. Median time from clinical onset to recanalization was 5 h 11 min. Procedure-related complications occurred in 5 % of patients, and 7.5 % had a symptomatic intracerebral hemorrhage. Of the patients, 22.5 % died within the first 90 postprocedural days, 5 % of these from cerebral causes. Patients who were successfully recanalized had a clinical better outcome at follow-up than those in whom treatment failed. Of the patients, 35.9 % had an mRS score {<=}2 after 90 days. Conclusion: Our results are in line with those in the published literature and show that a treatment strategy with general interventional radiologists performing neurointerventional procedures in acute stroke patients with large vessel occlusions can be achieved to the benefit of patients.

  14. Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery

    OpenAIRE

    Jianu, DC; Muresanu, DF; Bajenaru, O; Popescu, BO; Deme, SM; Moessler, H; Meinzingen, SZ; Petrica, L; Serpe, M; Ursoniu, S.

    2010-01-01

    Background: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke. Methods: We registered 2,212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20%75 years, admis...

  15. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients

    OpenAIRE

    Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak

    2015-01-01

    [Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measure...

  16. Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

    OpenAIRE

    Hong, Keun-Sik; Ko, Sang-Bae; Yu, Kyung-Ho; Jung, Cheolkyu; Park, Sukh Que; Kim, Byung Moon; Chang, Chul-Hoon; Bae, Hee-Joon; Heo, Ji Hoe; Oh, Chang Wan; Lee, Byung-Chul; Kim, Bum-Tae; Kim, Bum-soo; Chung, Chin-Sang; Yoon, Byung-Woo

    2016-01-01

    Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, ...

  17. Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Larsen, B; Herning, M;

    1983-01-01

    In a group of 48 patients with completed stroke, 8 patients had viable collaterally perfused brain tissue which was accessible for rCBF recordings with a two dimensional technique. All 8 had deep subcortical infarcts on CT-scan, and angiographic occlusion of the arteries normally supplying the in...... the experimental finding of an ischemic penumbra associated with acute cerebral infarcts and suggest that early restoration of the blood flow in acute stroke patients might improve recovery and prognosis in selected patients....

  18. Posterior reversible encephalopathy syndrome: an acute manifestation of systemic lupus erythematous.

    Science.gov (United States)

    Chan, Dexter Yak Seng; Ong, Yin Sheng

    2013-09-01

    Stroke mimickers are common, and they represent a diagnostic dilemma for clinicians. Many, like posterior reversible encephalopathy syndrome (PRES), are easily reversible. The manifestation of PRES is characterised by headaches, convulsions, altered mental functioning and blindness. In most cases, computed tomography of the brain will show hypodense lesions in the parieto-occpitial lobe, which only further confounds the physician. Although this syndrome is uncommon, prompt and accurate recognition allows early treatment, which has been shown to produce favourable outcomes. Herein, we report the case of a 54-year-old woman, who presented with PRES, as an acute manifestation of systemic lupus erythematous (SLE) and lupus nephritis. The patient was initially thought to be experiencing an ischaemic stroke, but the diagnosis was later changed. On management of her underlying condition, her symptoms resolved. PRES should be recognised as an acute emergency manifestation of SLE. It should not be mistaken for an ischaemic stroke as inappropriate treatment could have adverse outcomes. PMID:24068069

  19. Acute stroke trials: the problems of local investigators?

    Science.gov (United States)

    Toni, D; Sacchetti, M L; Chamorro, A

    2003-01-01

    During stroke trials local investigators have to face many practical problems and time consuming procedures (filling in huge case report forms, performing repeat blood sample drawings for pharmacokinetic studies etc.) which, however, simply require organizational structures which is understood to be necessary to be able to conduct such kind of studies. Other, and most worrisome problems, are indeed to be solved when a sponsored research may rise potential ethical issues, or when academic research proposals clash with the interest of pharmaceutical companies or find difficulties in being funded by public institutions. It is just a greater involvement of these latter, possibly free from bureaucratic laces, which might help a balance to be struck between academic and industrial aims. PMID:12584421

  20. MR-visible brain water content in human acute stroke

    DEFF Research Database (Denmark)

    Gideon, P; Rosenbaum, S; Sperling, B;

    1999-01-01

    Quantification of metabolite concentrations by proton magnetic resonance spectroscopy (1H-MRS) in the human brain using water as an internal standard is based on the assumption that water content does not change significantly in pathologic brain tissue. To test this, we used 1H-MRS to estimate......CBF from Day 0-3 to Day 4-7 (p = 0.050) and from Day 0-3 to Day 8-21 (p = 0.028). No correlation between rCBF and water content was found. Water content in ischemic brain tissue increased significantly between Day 4-7 after stroke. This should be considered when performing quantitative 1H-MRS using water...

  1. Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging).

    Science.gov (United States)

    Varadharajan, Shriram; Saini, Jitender; Acharya, Ullas V; Gupta, Arun Kumar

    2016-02-01

    Imaging in acute stroke has traditionally focussed on the 4Ps-parenchyma, pipes, perfusion, and penumbra-and has increasingly relied upon advanced techniques including magnetic resonance imaging to evaluate such patients. However, as per European Magnetic Resonance Forum estimates, the availability of magnetic resonance imaging scanners for the general population in India (0.5 per million inhabitants) is quite low as compared to Europe (11 per million) and United States (35 per million), with most of them only present in urban cities. On the other hand, computed tomography (CT) is more widely available and has reduced scanning duration. Computed tomography angiography of cervical and intracranial vessels is relatively simpler to perform with extended coverage and can provide all pertinent information required in such patients. This imaging review will discuss relevant imaging findings on CT angiography in patients with acute ischemic stroke through illustrated cases.

  2. [Chronic ischaemic heart disease in the elderly].

    Science.gov (United States)

    Martínez-Sellés, Manuel; Gómez Huelgas, Ricardo; Abu-Assi, Emad; Calderón, Alberto; Vidán, María Teresa

    2016-01-01

    It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging. PMID:27102136

  3. Clinical implications of sulcal enhancement on postcontrast fluid attenuated inversion recovery images in patients with acute stroke symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyuk Joon; Kim, Eun Hee; Lee, Kyung Mi; Kim, Jae Hyoung; Bae, Yun Jung; Choi, Byoung Se; Jung, Cheol Kyu [Dept. of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-08-15

    Hyperintense acute reperfusion marker (HARM) without diffusion abnormalities is occasionally found in patients with an acute stroke. This study was to determine the prevalence and clinical implications of HARM without diffusion abnormalities. There was a retrospective review of magnetic resonance images 578 patients with acute strokes and identified those who did not have acute infarction lesions, as mapped by diffusion-weighted imaging (DWI). These patients were classified into an imaging-negative stroke and HARM without diffusion abnormalities groups, based on the DWI findings and postcontrast fluid attenuated inversion recovery images. The National Institutes of Health Stroke Scale (NIHSS) scores at admission, 1 day, and 7 days after the event, as well as clinical data and risk factors, were compared between the imaging-negative stroke and HARM without diffusion abnormalities groups. Seventy-seven acute stroke patients without any DWI abnormalities were found. There were 63 patients with an imaging-negative stroke (accounting for 10.9% of 578) and 13 patients with HARM without diffusion abnormalities (accounting for 2.4% of 578). The NIHSS scores at admission were higher in HARM without diffusion abnormalities group than in the imaging-negative stroke group (median, 4.5 vs. 1.0; p < 0.001), but the scores at 7 days after the event were not significantly different between the two groups (median, 0 vs. 0; p = 1). The patients with HARM without diffusion abnormalities were significantly older, compared with patients with an imaging-negative stroke (mean, 73.1 years vs. 55.9 years; p < 0.001). Patients with HARM without diffusion abnormalities are older and have similarly favorable short-term neurological outcomes, compared with the patients with imaging-negative stroke.

  4. National Trends in the Utilization of Emergency Medical Services for Acute Myocardial Infarction and Stroke

    Directory of Open Access Journals (Sweden)

    Katie Tataris

    2014-11-01

    Full Text Available Introduction: The emergency medical services (EMS system plays a crucial role in the chain of survival for acute myocardial infarction (AMI and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. Methods: Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis. Results: In the study, there were 442 actual AMI patients and 220 (49.8% presented via EMS. There were 1,324 actual stroke patients and 666 (50.3% presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12-1.31, Non-Hispanic black race (OR 1.72; 95% CI 1.16-2.29, and nursing home residence (OR 11.50; 95% CI 6.19-21.36. Conclusion: In a nationally representative sample of ED visits from 20003-2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions. [West J Emerg Med. 2014;15(7:–0.

  5. A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke.

    Science.gov (United States)

    Sauser, Kori; Burke, James F; Reeves, Mathew J; Barsan, William G; Levine, Deborah A

    2014-09-01

    Acute stroke is an important focus of quality improvement efforts. There are many organizations involved in quality measurement for acute stroke, and a complex landscape of quality measures exists. Our objective is to describe and evaluate existing US quality measures for the emergency care of acute ischemic stroke patients in the emergency department (ED) setting. We performed a systematic review of the literature to identify the existing quality measures for the emergency care of acute ischemic stroke. We then convened a panel of experts to appraise how well the measures satisfy the American College of Cardiology/American Heart Association (ACC/AHA) criteria for performance measure development (strength of the underlying evidence, clinical importance, magnitude of the relationship between performance and outcome, and cost-effectiveness). We identified 7 quality measures relevant to the emergency care of acute ischemic stroke that fall into 4 main categories: brain imaging, thrombolytic administration, dysphagia screening, and mortality. Three of the 7 measures met all 4 of the ACC/AHA evaluation criteria: brain imaging within 24 hours, thrombolytic therapy within 3 hours of symptom onset, and thrombolytic therapy within 60 minutes of hospital arrival. Measures not satisfying all evaluation criteria were brain imaging report within 45 minutes, consideration for thrombolytic therapy, dysphagia screening, and mortality rate. There remains room for improvement in the development and use of measures that reflect high-quality emergency care of acute ischemic stroke patients in the United States.

  6. A Smartphone Client-Server Teleradiology System for Primary Diagnosis of Acute Stroke

    OpenAIRE

    Mitchell, J. Ross; Sharma, Pranshu; Modi, Jayesh; Simpson, Mark; Thomas, Monroe; Michael D Hill; Goyal, Mayank

    2011-01-01

    Background Recent advances in the treatment of acute ischemic stroke have made rapid acquisition, visualization, and interpretation of images a key factor for positive patient outcomes. We have developed a new teleradiology system based on a client-server architecture that enables rapid access to interactive advanced 2-D and 3-D visualization on a current generation smartphone device (Apple iPhone or iPod Touch, or an Android phone) without requiring patient image data to be stored on the dev...

  7. Trousseau’s Syndrome, a Previously Unrecognized Condition in Acute Ischemic Stroke Associated With Myocardial Injury

    OpenAIRE

    Thalin, Charlotte; Blomgren, Bo; Mobarrez, Fariborz; Lundstrom, Annika; Laska, Ann Charlotte; von Arbin, Magnus; von Heijne, Anders; Rooth, Elisabeth; Wallen, Hakan; Aspberg, Sara

    2014-01-01

    Trousseau’s syndrome is a well-known malignancy associated hypercoagulative state leading to venous or arterial thrombosis. The pathophysiology is however poorly understood, although multiple mechanisms are believed to be involved. We report a case of Trousseau’s syndrome resulting in concomitant cerebral and myocardial microthrombosis, presenting with acute ischemic stroke and markedly elevated plasma troponin T levels suggesting myocardial injury. Without any previous medical history, the p...

  8. Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke

    OpenAIRE

    Hill, M D; Barber, P.A.; Takahashi, J.; Demchuk, A.M.; Feasby, T E; Buchan, A M

    2000-01-01

    Among 105 patients given recombinant tissue plasminogen activator (rt-PA, alteplase) intravenously for acute stroke, 2 (1.9%) had lingual angioedema, which progressed to a fatal anaphylactoid reaction in 1. The authors review the 2 cases and possible mechanisms responsible. They warn that patients who are taking an angiotensin-converting-enzyme inhibitor may be at increased risk for angioedema with concomitant alteplase therapy.

  9. PEER REVIEW (L-Glutamate profile in Acute Ischemic Stroke after Intra Arterial Heparin Flushing )

    OpenAIRE

    Islam, Andi Asadul

    2016-01-01

    - PEER REVIEW Judul karya Ilmiah (artikel): L-Glutamate profile in Acute Ischemic Stroke after Intra Arterial Heparin Flushing 5 Orang Penulis Kelima a. Nama Jurnal : Bali Medical Journal b. Nomor ISSN : P: 2089-1180, E: 2302-2914 c. Volume,nomor, bulan, tahun : Volume 5, No. 3 Tahun 2016 d. Penerbit : Bali Med J e. DOI artikel (Jika ada) : f. Alamat web Jurnal : www.balimedicaljournal.org, www.ojs.unud.ac.id g. Terindeks di Scimagojr/

  10. Serial measurements of N-terminal pro-brain natriuretic peptide after acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, J K; Mickley, H; Bak, S;

    2006-01-01

    consecutive patients with acute ischemic stroke. RESULTS: NT-proBNP peaked the day after onset of symptoms (p = 0.007) followed by a decrease until day 5 (p = 0.001, ANOVA). At 6-month follow-up the difference in the level of NT-proBNP was unchanged compared to day 5 (p = 0.42). NT-proBNP levels > or =615 pg...

  11. Are in-Hospital Delays Important Obstacles in Thrombolytic Therapy Following Acute Ischemic Stroke?

    OpenAIRE

    Choi, Jay Chol; Kang, Sa-Yoon; Kang, Ji-Hoon; Ko, Yeo-Ju; Bae, Jong-Myon

    2007-01-01

    Background and purpose The advances in the diagnosis and treatment of acute stroke increase the importance of providing these patients with timely medical attention. This study was designed to assess time delays in neurological evaluation and neuroimaging and to determine whether they are important obstacles to performing thrombolytic therapy. Methods Data were obtained between May 2004 and September 2006 from 195 consecutive patients who were admitted to Cheju National University Hospital fo...

  12. Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

    Science.gov (United States)

    Choi, Nari; Yoon, Jee-Eun; Park, Byoung-Won; Chang, Won-Ho; Kim, Hyun-Jo; Lee, Kyung Bok

    2016-01-01

    We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding. PMID:27734002

  13. Stroke

    International Nuclear Information System (INIS)

    The advent of computed tomography (CT) in the early 1970s greatly facilitated the diagnosis and management of stroke and added significantly to our understanding of the pathophysiologic brain alterations it causes in humans. With CT it is now possible for the first time to noninvasively and reliably diagnose and distinguish between stroke resulting from cerebral infraction and that resulting from cerebral hemorrhage. In addition, other brain lesions that at times may clinically present as stroke-like syndromes, such as primary or metastatic brain tumor, brain abscess, or subdural hematoma, can usually be clearly differentiated by the CT examination. In most instances it is no longer necessary to perform cerebral angiography to exclude a possible surgical lesion in patients in whom the clinical diagnosis of stroke may have been in doubt

  14. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Layton, Kennith F.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); White, J. Bradley [Mayo Clinic, Department of Neurosurgery, Rochester, MN, (United States); Manno, Edward M. [Mayo Clinic, Department of Neurology, Rochester, MN, (United States)

    2006-06-15

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  15. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    International Nuclear Information System (INIS)

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  16. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients.

    Science.gov (United States)

    Long, Xue; Lou, Yongzhong; Gu, Hongfei; Guo, Xiaofei; Wang, Tao; Zhu, Yanxia; Zhao, Wenjuan; Ning, Xianjia; Li, Bin; Wang, Jinghua; An, Zhongping

    2016-01-01

    Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P dependency, all P dependency after stroke.

  17. Role of Diffusion-weighted Imaging in Acute Stroke Management using Low-field Magnetic Resonance Imaging in Resource-limited Settings

    OpenAIRE

    Okorie, Chinonye K; Ogbole, Godwin I.; Owolabi, Mayowa O; Ogun, Olufunmilola; Adeyinka, Abiodun; Ogunniyi, Adesola

    2015-01-01

    A variety of imaging modalities exist for the diagnosis of stroke. Several studies have been carried out to ascertain their contribution to the management of acute stroke and to compare the benefits and limitations of each modality. Diffusion-weighted imaging (DWI) has been described as the optimal imaging technique for diagnosing acute ischemic stroke, yet limited evidence is available on the value of DWI in the management of ischemic stroke with low-field magnetic resonance (MR) systems. Al...

  18. Feasibility of endovascular and surface cooling strategies in acute stroke

    DEFF Research Database (Denmark)

    Ovesen, Christian Hjerrild; Brizzi, M; Pott, F C;

    2012-01-01

    and surface cooling. METHODS: COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmö (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular......-based strategy. RESULTS: Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH...... patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control...

  19. Functional gain following rehabilitation of recurrent ischemic stroke in the elderly: experience of a post-acute care rehabilitation setting.

    Science.gov (United States)

    Mizrahi, E H; Fleissig, Y; Arad, M; Adunsky, A

    2015-01-01

    The aim of the study was to evaluate whether rehabilitation of patients with recurrent ischemic strokes is associated with functional gain. We studied a total of 919 consecutive post-acute ischemic stroke elderly patients admitted for rehabilitation. 22% out of the patients had recurrent stroke on index day. Functional outcomes of first-ever stroke patients and recurrent ischemic stroke patients were assessed by the Functional Independence Measurement scale (FIM™) at admission and discharge. Data was analyzed by t-test, Chi-square test and by multiple linear regression analysis. There were 716 patients with first ever stroke and 203 patients with recurrent stroke. Total and motor FIM scores at admission and total, motor, gain and Montebello Rehabilitation Factor (RFG) FIM scores at discharge were similar in the two groups. A multiple linear regression analysis showed that age (beta=-0.13, p=0.001) length of stay (beta=0.21, pstroke admitted to rehabilitation ward, showed similar FIM gain scores at discharge, compared with first-ever stroke patients. It is concluded that recurrent stroke should not be considered as adversely affecting the short-term functional outcomes of patients in a post-acute rehabilitation setting.

  20. Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke

    Science.gov (United States)

    Amiri-Nikpour, Mohammad Reza; Nazarbaghi, Surena; Ahmadi-Salmasi, Babak; Mokari, Tayebeh; Tahamtan, Urya; Rezaei, Yousef

    2014-01-01

    Background Cerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow. Methods In a randomized, double-blinded, placebo-controlled trial, 46 patients who had acute focal ischemic stroke were randomly assigned into two groups to receive intravenously either 30 mL of cerebrolysin diluted in normal saline daily for 10 days (n=23) or normal saline alone (n=23) adjunct to 100 mg of aspirin daily. All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index (PI) of their cerebral arteries at baseline as well as on days 30, 60, and 90. Results The patients’ mean age was 60±9.7 years, and 51.2% of patients were male. The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 (median 10, interquartile range 9–11, P=0.008) and day 90 (median 11, interquartile range 10–13.5, P=0.001). The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30, 60, and 90 (P<0.05). One patient in the cerebrolysin group and two patients in the placebo group died before day 30 (4.3% versus 8.7%). Conclusion Cerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke. PMID:25516711

  1. Perfusion differences on SPECT and PWI in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nuutinen, Juho [Kuopio University Hospital, University of Kuopio, Department of Neurology, Kuopio (Finland); Liu, Yawu; Laakso, Mikko P. [Kuopio University Hospital, University of Kuopio, Department of Neurology, Kuopio (Finland); Kuopio University Hospital, University of Kuopio, Department of Clinical Radiology, P. O. Box 1777, Kuopio (Finland); Karonen, Jari O. [Mikkeli Central Hospital, Department of Radiology, Mikkeli (Finland); Vanninen, Esko J. [Kuopio University Hospital, University of Kuopio, Department of Clinical Physiology and Nuclear Medicine, Kuopio (Finland); Kuikka, Jyrki T. [Kuopio University Hospital, University of Kuopio, Department of Clinical Physiology and Nuclear Medicine, Kuopio (Finland); Niuvanniemi Hospital, Kuopio (Finland); Aronen, Hannu J. [University of Turku, Department of Radiology, Turku (Finland); Vanninen, Ritva L. [Kuopio University Hospital, University of Kuopio, Department of Clinical Radiology, P. O. Box 1777, Kuopio (Finland)

    2009-10-15

    The purposes of the present study were to compare the flow defect volumes on perfusion-weighted magnetic resonance imaging (PWI) and {sup 99m}Tc-labeled ethylcysteinate dimer ({sup 99m}Tc-ECD) single photon emission computed tomography (SPECT) at acute and subacute stages of ischemic stroke and to analyze the relationship between the detected flow defects on the two methods and neurological status and clinical outcomes. Perfusion defects on PWI and SPECT were measured within 48 h and on day 8 of the onset of stroke from 22 patients with their first-ever acute supratentorial ischemic stroke. The primary neurological status was evaluated prior to the imaging. Clinical outcome was assessed at 3 months after the onset of the stroke. The volumes of cerebral blood flow (CBF) defects did not differ between SPECT and PWI within the 48-h examinations. However, the volume of CBF defect was significantly larger on SPECT than on PWI on day 8 (p = 0.03). Within the 48-h examinations, the CBF defect volumes on SPECT and PWI were comparably related to the neurological status. On day 8, the CBF defect volume on SPECT showed higher correlation to the neurological status and more precisely predicted the clinical outcomes at 3 months than PWI. {sup 99m}TC-ECD-SPECT and PWI both have ability to detect cerebral hypoperfusion in patients with ischemic stroke but with some differences. The value of SPECT is more accurate in terms of the delayed outcome, such as prognosis and rehabilitation planning. (orig.)

  2. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  3. Analysis of acute ischemic stroke presenting classic lacunar syndrome. A study by diffusion-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Terai, Satoshi; Ota, Kazuki; Tamaki, Kinya [Hakujyuji Hospital, Fukuoka (Japan)

    2002-03-01

    We retrospectively assessed the pathophysiological features of acute ischemic stroke presenting ''classic'' lacunar syndrome by using diffusion-weighted imaging (DWI). Subjects were 16 patients who were admitted to our hospital within 24 hours of stroke onset and underwent DWI examination on admission. These were divided into three categorical groups; pure motor hemiplegia (PMH) in 8, sensorimotor stroke (SMS) in 7, and dysarthria-clumsy hand syndrome (DCHS) in 1. The fresh responsible lesions were identified by DWI in the perforating territory in 7 patients with PMH and 7 with SMS. Four (one had two possible response lesions; pons and corona radiata) and five patients in the respective groups were diagnosed as lacunar infarction on admission (the largest dimension of the lesion measuring smaller than 15 mm). On the contralateral side to the neurological symptoms, DWI revealed high intensities in cortex, subcortical white matter, and anterior and posterior border zones in the remaining one patient with PMH and in the precentral arterial region in one with DCHS. They were diagnosed as atherothrombotic infarction resulting from the occlusion of the internal carotid artery and cerebral embolism due to atrial fibrillation, respectively. Three patients with PMH showed progressive deterioration after admission and follow-up DWI study in an acute stage revealed enlargement of heir ischemic lesions. The present study suggests that DWI is a useful imaging technique for diagnosis of clinical categories and observation for pathophsiological alteration in the acute ischemic stroke patients with ''classic'' lacunar syndrome. Our results also indicate a necessity to be aware that various types of fresh ischemic lesions other than a single lacune might possibly be developing in cases with this syndrome. (author)

  4. Risks and benefits of early antithrombotic therapy after thrombolytic treatment in patients with acute stroke.

    Directory of Open Access Journals (Sweden)

    Sergio Amaro

    Full Text Available BACKGROUND: Current guidelines recommend withholding antithrombotic therapy (ATT for at least 24 h in patients with acute ischemic stroke treated with thrombolytic therapy. Herein, we report a retrospective analysis of a single-centre experience on the safety and efficacy of antithrombotic therapy (ATT started before or after 24 h of intravenous thrombolysis in a cohort of acute ischemic stroke patients. METHODS: A total of 139 patients (Rapid ATT group received antithrombotic therapy before 24 h of thrombolysis, and 33 patients (Standard ATT group after 24 h. The brain parenchyma and vessel status were assessed using simple CT scan on admission, multimodal CT scan at the end of thrombolysis, and angio-CT/MRI scan at day 3. Functional outcome was scored using the modified Rankin Scale (mRS at day 90. RESULTS: The two ATT groups had similar demographics, stroke subtypes, baseline NIHSS, thrombolytic strategies, vessel-patency rates at the end of thrombolysis, and incidence of bleeding complications at follow up. At day 3, the Rapid ATT group had a non-significant improved vessel-patency rate than the Standard ATT group. At day 90, a greater proportion of patients in the rapid ATT group had shifted down the mRS, and had improved in the NIHSS score. CONCLUSIONS: ATT initiated before 24 h of intravenous thrombolytic therapy in acute stroke patients disclosed no safety concerns compared with a conventional antithrombotic therapy delay of 24 h and showed better functional outcome at follow up. The value of early initiation of ATT after thrombolysis deserves further assessment in randomized controlled trials.

  5. In-111-labeled leukocyte brain SPECT imaging in acute ischemic stroke in man

    International Nuclear Information System (INIS)

    This study was performed to investigate the role of leukocyte accumulation in human cerebral infarction and its association with neurological functional outcome. A total of 42 patients diagnosed as acute ischemic stroke (22 embolism, 17 thrombosis, 3 TIA) were examined. Leukocyte accumulation was studied using indium-111-labeled leukocyte brain SPECT. Volume of brain infarction was evaluated by CT and/or MRI. The data were compared with the cerebral blood flow (CBF) imaging. Immediately after CBF study by SPECT using either Tc-99m-HMPAO or Tc-99m-ECD, In-111-labeled autologous leukocytes were injected intravenously. Brain scan for leukocytes was performed after 48 hours. The European Stroke Scale was used for neurological assessment. Thirteen patients with cerebral embolism and three patients with cerebral thrombosis showed intensive accumulation of leukocytes in the region of low flow Leukocyte's accumulation was not seen in patients with TIA. The accumulation of leukocytes was more noticeable in the central zone of the ischemia. Patients who showed negative leukocyte accumulation revealed clinically mild functional outcome and the size of infarction on CT and/or MRI was small. The regional accumulation of leukocytes was seen in all the patients with hemorrhagic infarction, but the degree of hemorrhage on CT did not have significant influence on the amount of leukocyte accumulation. Abnormal accumulation of leukocytes was associated with reduced CBF during the acute embolic stroke. The present clinical study revealed that leukocyte accumulation correlated with the poor neurological functional outcome in patients with acute embolic stroke. (K.H.)

  6. Intravoxel incoherent motion perfusion imaging in acute stroke: initial clinical experience

    International Nuclear Information System (INIS)

    Intravoxel incoherent motion (IVIM) imaging is an MRI perfusion technique that uses a diffusion-weighted sequence with multiple b values and a bi-compartmental signal model to measure the so-called pseudo-diffusion of blood caused by its passage through the microvascular network. The goal of the current study was to assess the feasibility of IVIM perfusion fraction imaging in patients with acute stroke. Images were collected in 17 patients with acute stroke. Exclusion criteria were onset of symptoms to imaging >5 days, hemorrhagic transformation, infratentorial lesions, small lesions 2. Image quality was assessed by two radiologists, and quantitative analysis was performed in regions of interest placed in the stroke area, defined by thresholding the apparent diffusion coefficient maps, as well as in the contralateral region. IVIM perfusion fraction maps showed an area of decreased perfusion fraction f in the region of decreased apparent diffusion coefficient. Quantitative analysis showed a statistically significant decrease in both IVIM perfusion fraction f (0.026 ± 0.019 vs. 0.056 ± 0.025, p = 2.2 . 10-6) and diffusion coefficient D compared with the contralateral side (3.9 ± 0.79 . 10-4 vs. 7.5 ± 0.86 . 10-4 mm2/s, p = 1.3 . 10-20). IVIM perfusion fraction imaging is feasible in acute stroke. IVIM perfusion fraction is significantly reduced in the visible infarct. Further studies should evaluate the potential for IVIM to predict clinical outcome and treatment response. (orig.)

  7. In-111-labeled leukocyte brain SPECT imaging in acute ischemic stroke in man

    Energy Technology Data Exchange (ETDEWEB)

    Fujinuma, Kunihiko; Sakai, Fumihiko; Iizuka, Takahiro; Kitai, Norio [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    1997-01-01

    This study was performed to investigate the role of leukocyte accumulation in human cerebral infarction and its association with neurological functional outcome. A total of 42 patients diagnosed as acute ischemic stroke (22 embolism, 17 thrombosis, 3 TIA) were examined. Leukocyte accumulation was studied using indium-111-labeled leukocyte brain SPECT. Volume of brain infarction was evaluated by CT and/or MRI. The data were compared with the cerebral blood flow (CBF) imaging. Immediately after CBF study by SPECT using either Tc-99m-HMPAO or Tc-99m-ECD, In-111-labeled autologous leukocytes were injected intravenously. Brain scan for leukocytes was performed after 48 hours. The European Stroke Scale was used for neurological assessment. Thirteen patients with cerebral embolism and three patients with cerebral thrombosis showed intensive accumulation of leukocytes in the region of low flow Leukocyte`s accumulation was not seen in patients with TIA. The accumulation of leukocytes was more noticeable in the central zone of the ischemia. Patients who showed negative leukocyte accumulation revealed clinically mild functional outcome and the size of infarction on CT and/or MRI was small. The regional accumulation of leukocytes was seen in all the patients with hemorrhagic infarction, but the degree of hemorrhage on CT did not have significant influence on the amount of leukocyte accumulation. Abnormal accumulation of leukocytes was associated with reduced CBF during the acute embolic stroke. The present clinical study revealed that leukocyte accumulation correlated with the poor neurological functional outcome in patients with acute embolic stroke. (K.H.)

  8. Intravoxel incoherent motion perfusion imaging in acute stroke: initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Federau, C.; Becce, F.; Maeder, P.; Meuli, R. [Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Sumer, S.; Wintermark, M. [University of Virginia, Neuroradiology Division, Department of Radiology, Charlottesville, VA (United States); O' Brien, K. [University of Geneva, Center for Biomedical Imaging (CIBM), Geneva (Switzerland)

    2014-08-15

    Intravoxel incoherent motion (IVIM) imaging is an MRI perfusion technique that uses a diffusion-weighted sequence with multiple b values and a bi-compartmental signal model to measure the so-called pseudo-diffusion of blood caused by its passage through the microvascular network. The goal of the current study was to assess the feasibility of IVIM perfusion fraction imaging in patients with acute stroke. Images were collected in 17 patients with acute stroke. Exclusion criteria were onset of symptoms to imaging >5 days, hemorrhagic transformation, infratentorial lesions, small lesions <0.5 cm in minimal diameter and hemodynamic instability. IVIM imaging was performed at 3 T, using a standard spin-echo Stejskal-Tanner pulsed gradients diffusion-weighted sequence, using 16 b values from 0 to 900 s/mm{sup 2}. Image quality was assessed by two radiologists, and quantitative analysis was performed in regions of interest placed in the stroke area, defined by thresholding the apparent diffusion coefficient maps, as well as in the contralateral region. IVIM perfusion fraction maps showed an area of decreased perfusion fraction f in the region of decreased apparent diffusion coefficient. Quantitative analysis showed a statistically significant decrease in both IVIM perfusion fraction f (0.026 ± 0.019 vs. 0.056 ± 0.025, p = 2.2 . 10{sup -6}) and diffusion coefficient D compared with the contralateral side (3.9 ± 0.79 . 10{sup -4} vs. 7.5 ± 0.86 . 10{sup -4} mm{sup 2}/s, p = 1.3 . 10{sup -20}). IVIM perfusion fraction imaging is feasible in acute stroke. IVIM perfusion fraction is significantly reduced in the visible infarct. Further studies should evaluate the potential for IVIM to predict clinical outcome and treatment response. (orig.)

  9. Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Huanmin Gao; Xugang Li; Xia Gao; Benxu Ma

    2013-01-01

    Hemiplegia caused by stroke indicates dysfunction of the network between the brain and limbs, namely col ateral shock in the brain. Contralateral needling is the insertion of needles into acupoints on the relative healthy side of the body to treat diseases such as apoplexy. However, there is little wel-designed and control ed clinical evidence for this practice. This study investigated whether contralateral needling could treat hemiplegia after acute ischemic stroke in 106 randomly selected patients with acute ischemic stroke. These patients were randomly assigned to three groups:45 in the contralateral needling group, receiving acupuncture on the unaffected limbs; 45 in the tional acupuncture group, receiving acupuncture on the hemiplegic limbs; and 16 in the control group, receiving routine treatments without acupuncture. Acupuncture at acupoints Chize (LU5) in the upper limb and Jianliao (TE14) in the lower limb was performed for 45 minutes daily for 30 consecutive days. The therapeutic effective rate, Neurological Deficit Score, Modified Barthel Index and Fugl-Meyer Assessment were evaluated. The therapeutic effective rate of contralateral needl-ing was higher than that of conventional acupuncture (46.67% vs. 31.11%, P < 0.05). The neuro-logical deficit score of contralateral needling was significantly decreased compared with conven-tional acupuncture (P < 0.01). The Modified Barthel Index and Fugl-Meyer Assessment score of contralateral needling increased more significantly than those of conventional acupuncture (both P<0.01). The present findings suggest that contralateral needling unblocks col aterals and might be more effective than conventional acupuncture in the treatment of hemiplegia fol owing acute ischemic stroke.

  10. MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting.

    Science.gov (United States)

    Berritto, Daniela; Iacobellis, Francesca; Mazzei, Maria Antonietta; Volterrani, Luca; Guglielmi, Giuseppe; Brunese, Luca; Grassi, Roberto

    2016-01-01

    Ischemic colitis (IC) is the most common vascular disorder of the gastrointestinal tract with a reported incidence of 6.1-44 cases/100,000 person years with confirmatory histopathology. However, the true incidence of IC poses some difficulty, and even vigilant clinicians with patients at high risk often miss the diagnosis, since clinical presentation is non-specific or could have a mild transient nature. Detection of IC results is crucial to plan the correct therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of IC is based on a combination of clinical suspicion, radiological, endoscopic and histological findings. Some consider colonoscopy as a diagnostic test of choice; however, preparation is required and it is not without risk, above all in patients who are severely ill. There are two manifestations of vascular colonic insult: ischaemic and reperfusive. The first one occurs above all during ischaemic/non-occlusive mesenteric ischaemia; in this case, the colonic wall appears thinned with dilated lumen and fluid appears in the paracolic space. When reperfusion occurs, the large bowel wall appears thickened and stratified, because of subepithelial oedema and/or haemorrhage, with consequent lumen calibre reduction. Shaggy contour of the involved intestine and misty mesentery are associated with the pericolic fluid. The pericolic fluid results are a crucial finding for IC diagnosis since its evidence suggests the presence of an ongoing damage thus focusing the attention on other pathological aspects which could be otherwise misdiagnosed, such as thinned or thickened colonic wall. Moreover, the pericolic fluid may increase or decrease, depending on the evolution of the ischaemic damage, suggesting the decision of medical or surgical treatment. Radiologists should not forget the hypothesis of IC, being aware that multidetector CT could be sufficient to suggest the diagnosis of IC, allowing for early identification and grading definition, and

  11. Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST: study protocol for a pilot randomised controlled trial

    Directory of Open Access Journals (Sweden)

    McColl Elaine

    2011-06-01

    Full Text Available Abstract Background High blood pressure during acute stroke is associated with poorer stroke outcome. Previous trials have failed to show benefit from lowering blood pressure but treatment may have been commenced too late to be effective. The earliest that acute stroke treatments could be initiated is during contact with the emergency medical services (paramedics. However, experience of pre-hospital clinical trials is limited and logistical challenges are likely to be greater than for trials performed in other settings. We report the protocol for a pilot randomised controlled trial of paramedic initiated blood pressure lowering treatment for hypertension in acute stroke. Methods Trial Design: Double blind parallel group external pilot randomised controlled trial. Setting: Participant recruitment and initial treatment by North East Ambulance Service research trained paramedics responding to the emergency call. Continued treatment in three study hospitals. Participants: Target is recruitment of 60 adults with acute arm weakness due to suspected stroke (within 3 hours of symptom onset and hypertension (systolic BP>160 mmHg. Intervention: Lisinopril 5-10 mg (intervention group, matched placebo (control group, daily for 7 days. Randomisation: Study medication contained within identical pre-randomised "trial packs" carried by research trained paramedics. Outcomes: Study feasibility (recruitment rate, compliance with data collection and clinical data to inform the design of a definitive randomised controlled trial (blood pressure monitoring, National Institute of Health Stroke Scale, Barthel ADL Index, Modified Rankin Scale, renal function. Discussion This pilot study is assessing the feasibility of a randomised controlled trial of paramedic initiated lisinopril for hypertension early after the onset of acute stroke. The results will inform the design of a definitive RCT to evaluate the effects of very early blood pressure lowering in acute stroke

  12. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Jaydip Ray Chaudhuri

    2013-07-01

    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  13. Five Years of Acute Stroke Unit Care: Comparing ASU and Non-ASU Admissions and Allied Health Involvement

    Directory of Open Access Journals (Sweden)

    Isobel J. Hubbard

    2014-01-01

    Full Text Available Background. Evidence indicates that Stroke Units decrease mortality and morbidity. An Acute Stroke Unit (ASU provides specialised, hyperacute care and thrombolysis. John Hunter Hospital, Australia, admits 500 stroke patients each year and has a 4-bed ASU. Aims. This study investigated hospital admissions over a 5-year period of all strokes patients and of all patients admitted to the 4-bed ASU and the involvement of allied health professionals. Methods. The study retrospectively audited 5-year data from all stroke patients admitted to John Hunter Hospital (n=2525 and from nonstroke patients admitted to the ASU (n=826. The study’s primary outcomes were admission rates, length of stay (days, and allied health involvement. Results. Over 5 years, 47% of stroke patients were admitted to the ASU. More male stroke patients were admitted to the ASU (chi2=5.81; P=0.016. There was a trend over time towards parity between the number of stroke and nonstroke patients admitted to the ASU. When compared to those admitted elsewhere, ASU stroke patients had a longer length of stay (z=−8.233; P=0.0000 and were more likely to receive allied healthcare. Conclusion. This is the first study to report 5 years of ASU admissions. Acute Stroke Units may benefit from a review of the healthcare provided to all stroke patients. The trends over time with respect to the utilisation of the John Hunter Hospitall’s ASU have resulted in a review of the hospitall’s Stroke Unit and allied healthcare.

  14. Optimizing sedation in patients with acute brain injury

    OpenAIRE

    Oddo, Mauro; Crippa, Ilaria Alice; Mehta, Sangeeta; Menon, David; Payen, Jean-Francois; Taccone, Fabio Silvio; Citerio, Giuseppe

    2016-01-01

    Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradi...

  15. In-111-labeled leukocyte brain SPECT imaging. Clinical significance in evaluating acute ischemic stroke

    International Nuclear Information System (INIS)

    Many experimental studies have demonstrated that leukocyte infiltration plays an important role in the progression of ischemic cellular damage or post perfusion brain injury. However, only a few clinical studies have been reported. The purpose of this study is to evaluate the clinical significance of leukocyte accumulation in the ischemic brain tissue. Seventy six patients (49 men, 27 women; mean age: 65.5±13.9 years) with acute ischemic stroke were studied by leukocyte brain SPECT imaging. A diagnosis included cardioembolism (n=46), atherothrombotic infarction (n=24), TIA (n=3) and lacuna (n=3). Immediately after the CBF study using Tc-99m-ECD (600 MBq), indium-111-labeled autologous leukocytes were injected. A brain scan for leukocytes was performed 48 hours later. The leukocyte-SPECT study was made 11.1±7.7 days after the onset of stroke. Regional accumulation of leukocytes in the ischemic tissue was evaluated both by visual assessment and by measuring the hemispheric asymmetry index for leukocyte (AI-leuko), and was evaluated by comparison with variable factors including age, gender, infarction size, hemorrhagic transformation, timing of study after the onset, type of stroke and functional outcome. Of the 61 patients with acute ischemic stroke within 2 weeks of onset, 28 patients showed the accumulation of leukocytes in the central zone of ischemia. Six of 7 patients with repeated studies showed a reduction in leukocyte accumulation with time after the onset. Factors significantly associated with the higher accumulation of leukocyte included cardioembolic stroke, larger size of infarct, presence of hemorrhagic transformation and significant reduction in flow. In the 61 patients within 2 weeks of onset, the functional outcome was significantly correlated with the accumulation of leukocyte (p<0.001). The accumulation of leukocytes was seen more in patients with embolic stroke, larger infarction, and hemorrhagic transformation. The higher accumulation correlated

  16. In-111-labeled leukocyte brain SPECT imaging. Clinical significance in evaluating acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Fujinuma, Kunihiko [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    2002-02-01

    Many experimental studies have demonstrated that leukocyte infiltration plays an important role in the progression of ischemic cellular damage or post perfusion brain injury. However, only a few clinical studies have been reported. The purpose of this study is to evaluate the clinical significance of leukocyte accumulation in the ischemic brain tissue. Seventy six patients (49 men, 27 women; mean age: 65.5{+-}13.9 years) with acute ischemic stroke were studied by leukocyte brain SPECT imaging. A diagnosis included cardioembolism (n=46), atherothrombotic infarction (n=24), TIA (n=3) and lacuna (n=3). Immediately after the CBF study using Tc-99m-ECD (600 MBq), indium-111-labeled autologous leukocytes were injected. A brain scan for leukocytes was performed 48 hours later. The leukocyte-SPECT study was made 11.1{+-}7.7 days after the onset of stroke. Regional accumulation of leukocytes in the ischemic tissue was evaluated both by visual assessment and by measuring the hemispheric asymmetry index for leukocyte (AI-leuko), and was evaluated by comparison with variable factors including age, gender, infarction size, hemorrhagic transformation, timing of study after the onset, type of stroke and functional outcome. Of the 61 patients with acute ischemic stroke within 2 weeks of onset, 28 patients showed the accumulation of leukocytes in the central zone of ischemia. Six of 7 patients with repeated studies showed a reduction in leukocyte accumulation with time after the onset. Factors significantly associated with the higher accumulation of leukocyte included cardioembolic stroke, larger size of infarct, presence of hemorrhagic transformation and significant reduction in flow. In the 61 patients within 2 weeks of onset, the functional outcome was significantly correlated with the accumulation of leukocyte (p<0.001). The accumulation of leukocytes was seen more in patients with embolic stroke, larger infarction, and hemorrhagic transformation. The higher accumulation

  17. Acute Isolated Dysarthria Is Associated with a High Risk of Stroke

    Directory of Open Access Journals (Sweden)

    Alina Beliavsky

    2014-08-01

    Full Text Available Background: Isolated dysarthria is an uncommon presentation of transient ischemic attack (TIA/minor stroke and has a broad differential diagnosis. There is little information in the literature about how often this presentation is confirmed to be a TIA/stroke, and therefore there is debate about the risk of subsequent vascular events. Given the uncertain prognosis, it is unclear how to best manage patients presenting to the emergency department (ED with isolated dysarthria. The objective of this study was to prospectively identify and follow a cohort of patients presenting to EDs with isolated dysarthria in order to explore their natural history and risk of recurrent cerebrovascular events. Specifically, we sought to determine early outcomes of individuals with this nonspecific and atypical presentation in order to appropriately expedite their management. Methods: Patients with isolated dysarthria having presented to 8 Canadian EDs between October 2006 and April 2009 were analyzed as part of a prospective multicenter cohort study of patients with acute neurological symptoms as assessed by emergency physicians. The study inclusion criteria were age ≥18 years, a normal level of consciousness, and a symptom onset Results: Between 2006 and 2009, 1,528 patients were enrolled and had a 90-day follow-up. Of these, 43 patients presented with isolated acute-onset dysarthria (2.8%. Recurrent stroke occurred in 6/43 (14.0% within 90 days of enrollment. The predicted maximal 90-day stroke rate was 9.8% (based on a median ABCD2 score of 5 for the isolated dysarthria cohort. After adjusting for covariates, isolated dysarthria independently predicted stroke within 90 days (aOR: 3.96; 95% CI: 1.3-11.9; p = 0.014. Conclusions: The isolated dysarthria cohort carried a recurrent stroke risk comparable to that predicted by the median ABCD2 scores. Although isolated dysarthria is a nonspecific and uncommon clinical presentation of TIA, these findings support the

  18. Intravenous flat-detector CT angiography in acute ischemic stroke management

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, Raphael; Pistocchi, Silvia; Bartolini, Bruno; Piotin, Michel [Fondation Rothschild Hospital, Department of Interventional Neuroradiology, Paris (France); Babic, Drazenko [Philips Healthcare, Best (Netherlands); Obadia, Michael [Fondation Rothschild Hospital, Department of Neurology, Paris (France); Alamowitch, Sonia [APHP Hopital Tenon, Universite Paris VI, Department of Neurology, Paris (France)

    2012-04-15

    In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries. Fourteen consecutive patients elected for endovascular stroke therapy underwent IV FDCT. The scans were intravenously enhanced and acquired in accordance with the previously calculated bolus arrival time. Images were processed on a commercially available workstation for reconstructions and 3D manipulation. Occlusion level and clot length, the quality of collateral vessels, and the patency of anterior and posterior communicating arteries were assessed. IV FDCT was performed successfully in all the cases and allowed for clot location and length visualization, assessment of communicating arteries patency, and evaluation of vessel collateral grade. Information obtained from this technique was considered useful for patients treated by endovascular approach. Retrospective review of the images by two independent readers was considered accurate and reproducible. IV FDCT technology provided accurate delineation of obstructed vessel segments in acute ischemic stroke disease. It gave a significant help in the interventional strategy. This new technology available in the operating room might provide a valuable tool in emerging endovascular stroke therapy. (orig.)

  19. Modeling the Cost Effectiveness of Neuroimaging-Based Treatment of Acute Wake-Up Stroke.

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    Ankur Pandya

    Full Text Available Thrombolytic treatment (tissue-type plasminogen activator [tPA] is only recommended for acute ischemic stroke patients with stroke onset time 4.5 hours, 46.3% experienced a good stroke outcome. Lifetime discounted QALYs and costs were 5.312 and $88,247 for the no treatment strategy and 5.342 and $90,869 for the MRI-based strategy, resulting in an ICER of $88,000/QALY. Results were sensitive to variations in patient- and provider-specific factors such as sleep duration, hospital travel and door-to-needle times, as well as onset probability distribution, MRI specificity, and mRS utility values.Our model-based findings suggest that an MRI-based treatment strategy for this population could be cost-effective and quantifies the impact that patient- and provider-specific factors, such as sleep duration, hospital travel and door-to-needle times, could have on the optimal decision for wake-up stroke patients.

  20. Does HIPE data capture the complexity of stroke patients in an acute hospital setting?

    LENUS (Irish Health Repository)

    Clarke, B

    2010-01-01

    The Hospital Inpatient Enquiry (HIPE) system is currently used as a principle source of national data on discharges from acute hospitals. The Casemix Programme is used to calculate funding for patient care (HIPE activity and Specialty Costs Returns). Th coding is usually undertaken by clerical personnel. We were concerned that the medical complexity of our stroke patients was not captured by the process. The aims of this study were to compare activity coded by HIPE coding staff and medical staff in consecutive stroke patients discharged from the hospital. One hundred consecutive discharged patients with stroke as primary diagnosis were coded by clerical staff [usual practice] and by medical staff. We compared the coding and any differences. We calculated the financial comparison of subsequent differences in Diagnostic Related Groups (DRGs) and Relative Values (RVs). Clinician coded DRGs resulted in a higher assigned RV in 45 cases. The total RV value for HIPE using clerical coding was 595,268.94 euros and using medical coding was 725,252.16 euros. We conclude that medical input is useful in detailing the complications arising in stroke patients. We suggest that physicians should assist in the HIPE coding process in order to capture clinical complexity, so that funding can be appropriately assigned to manage these complex patients.

  1. High-Performance Upconversion Nanoprobes for Multimodal MR Imaging of Acute Ischemic Stroke.

    Science.gov (United States)

    Wang, Jing; Zhang, Hua; Ni, Dalong; Fan, Wenpei; Qu, Jianxun; Liu, Yanyan; Jin, Yingying; Cui, Zhaowen; Xu, Tianyong; Wu, Yue; Bu, Wenbo; Yao, Zhenwei

    2016-07-01

    Multimodal magnetic resonance (MR) imaging, including MR angiography (MRA) and MR perfusion (MRP), plays a critical role in the diagnosis and surveillance of acute ischemic stroke. However, these techniques are hindered by the low T1 relaxivity, short circulation time, and high leakage rate from vessels of clinical Magnevist. To address these problems, nontoxic polyethylene glycol (PEG)ylated upconversion nanoprobes (PEG-UCNPs) are synthesized and first adopted for excellent MRA and MRP imaging, featuring high diagnostic sensitivity toward acute ischemic stroke in high-resolution imaging. The investigations show that the agent possesses superior advantages over clinical Magnevist, such as much higher relaxivity, longer circulation time, and lower leakage rate, which guarantee much better imaging efficiency. Remarkably, an extremely small dosage (5 mg Gd kg(-1) ) of PEG-UCNPs provides high-resolution MRA imaging with the vascular system delineated much clearer than the Magnevist with clinical dosage as high as 108 mg Gd kg(-1) . On the other hand, the long circulation time of PEG-UCNPs enables the surveillance of the progression of ischemic stroke using MRA or MRP. Once translated, these PEG-UCNPs are expected to be a promising candidate for substituting the clinical Magnevist in MRA and MRP, which will significantly lengthen the imaging time window and improve the overall diagnostic efficiency. PMID:27219071

  2. Effect of rosuvastatin on inflammatory factors and carotid atherosclerotic plaque in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    YAN Jun

    2013-10-01

    Full Text Available Carotid atherosclerosis is closely related with ischemic stroke occurrence, development and recurrence. This study aims to make an evaluation of the effects of rosuvastatin on inflammatory factors, serum lipid and carotid atherosclerotic plaque in patients with acute ischemic stroke. In this study, 98 patients with acute ischemic stroke and carotid atherosclerosis were given oral administration of rosuvastatin calcium (10 mg once every night, and the course of treatment was 6 months. After treatment, the changes of serum high-sensitivity C-reactive protein (hs-CRP, tumor necrosis factor-alpha (TNF-α and blood lipid were measured, as well as carotid atherosclerotic intima-media thickness (IMT and the calculation of carotid atherosclerotic plaque score. According to the examination results, after 6 months' treatment with rosuvastatin, serum hs-CRP, TNF-α, total cholesterol (TC, triglyceride (TG and low-density lipoprotein cholestrol (LDL-C decreased significantly (P < 0.01, for all, while high-density lipoprotein cholestrol (HDL-C increased significantly (P < 0.01; the total number of plaque reduced, while the number of stable plaque increased (P < 0.05; carotid artery IMT and carotid artery plaque score decreased significantly (P < 0.05. There were significant differences between before and after treatment. The results of this study show that rosuvastatin plays a role in anti-inflammation and alleviates the degree of carotid atherosclerotic plaque.

  3. Electrical Bioimpedance Spectroscopy on Acute Unilateral Stroke Patients: Initial Observations regarding Differences between Sides

    Directory of Open Access Journals (Sweden)

    Fernando Seoane

    2015-01-01

    Full Text Available Purpose. Electrical Bioimpedance Cerebral Monitoring is assessment in real time of health of brain tissue through study of passive dielectric properties of brain. During the last two decades theory and technology have been developed in parallel with animal experiments aiming to confirm feasibility of using bioimpedance-based technology for prompt detection of brain damage. Here, for the first time, we show that electrical bioimpedance measurements for left and right hemispheres are significantly different in acute cases of unilateral stroke within 24 hours from onset. Methods. Electrical BIS measurements have been taken in healthy volunteers and patients suffering from acute stroke within 24 hours of onset. BIS measurements have been obtained using SFB7 bioimpedance spectrometer manufactured by Impedimed ltd. and 4-electrode method. Measurement electrodes, current, and voltage have been placed according to 10–20 EEG system obtaining mutual BIS measurements from 4 different channels situated in pairs symmetrically from the midsagittal line. Obtained BIS data has been analyzed, assessing for symmetries and differences regarding healthy control data. Results. 7 out of 10 patients for Side-2-Side comparisons and 8 out 10 for central/lateral comparison presented values outside the range defined by healthy control group. When combined only 1 of 10 patients exhibited values within the healthy range. Conclusions. If these initial observations are confirmed with more patients, we can foresee emerging of noninvasive monitoring technology for brain damage with the potential to lead to paradigm shift in treatment of brain stroke and traumatic brain damage.

  4. Neuroprotective effect of osthole against acute ischemic stroke on middle cerebral ischemia occlusion in rats.

    Science.gov (United States)

    Chao, Xiaodong; Zhou, Jun; Chen, Tao; Liu, Wenbo; Dong, Wenpeng; Qu, Yan; Jiang, Xiaofan; Ji, Xituan; Zhen, Haining; Fei, Zhou

    2010-12-01

    Osthole, a natural coumarin derivative, has taken considerable attention because of its diverse pharmacological functions. It has been reported to be useful in the treatment of chronic cerebral hypoperfusion and neuronal damage. In the present study, we examined the neuroprotective effect of osthole and its potential mechanisms against acute ischemic stroke induced by middle cerebral artery occlusion (MCAO) in rats. The rats were pretreated with osthole 10, 20 and 40 mg/kg 30 min before MCAO. The neuroprotective effect of osthole against acute ischemic stroke was evaluated by neurological deficit score (NDS), dry-wet weight and 2,3,5-triphenyltetrazolium chloride (TTC) staining. The contents of malondialdehyde (MDA) and glutathione (GSH), activity of myeloperoxidase (MPO) and the level of interleukin (IL)-1β and IL-8 after 2h of MCAO in rats were detected to investigate its anti-oxidative action and anti-inflammatory property. Pretreatment with osthole significantly increased in GSH, and decreased the volume of infarction, NDS, edema, MDA, MPO, IL-1β and IL-8 compared with rats in the MCAO group at 24h after MCAO. The study suggests the neuroprotective effect of osthole in the MCAO model of rats. The anti-oxidative action and anti-inflammatory property of osthole may contribute to a beneficial effect against stroke. PMID:20869955

  5. Global aphasia as a predictor of mortality in the acute phase of a first stroke

    Directory of Open Access Journals (Sweden)

    F F Oliveira

    2011-01-01

    Full Text Available OBJECTIVE: To establish whether vascular aphasic syndromes can predict stroke outcomes. METHOD: Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. RESULTS: Speech or language disabilities were found in seven (87.5% of the eight deceased patients and twenty-six (89.7% of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased, consisting on a risk factor for death in the acute stroke phase (ρ=0.022. Age (z=1.65; ρ>0.09, thrombolysis (ρ=0.591, infarct size (ρ=0.076 and side (ρ=0.649 did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. CONCLUSION: Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element.

  6. Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke

    Science.gov (United States)

    Taheraghdam, Aliakbar; Rikhtegar, Reza; Mehrvar, Kaveh; Mehrara, Mehrdad; Hassasi, Rogayyeh; Aliyar, Hannane; Farzi, Mohammadamin; Hasaneh Tamar, Somayyeh

    2016-01-01

    Background. Intravenous tissue plasminogen activator, a time dependent therapy, can reduce the morbidity and mortality of acute ischemic stroke. This study was designed to assess the effect of simple in-hospital interventions on reducing door-to-CT (DTC) time and reaching door-to-needle (DTN) time of less than 60 minutes. Methods. Before any intervention, DTC time was recorded for 213 patients over a one-year period at our center. Five simple quality-improvement interventions were implemented, namely, call notification, prioritizing patients for CT scan, prioritizing patients for lab analysis, specifying a bed for acute stroke patients, and staff education. After intervention, over a course of 44 months, DTC time was recorded for 276 patients with the stroke code. Furthermore DTN time was recorded for 106 patients who were treated with IV thrombolytic therapy. Results. The median DTC time significantly decreased in the postintervention period comparing to the preintervention period [median (IQR); 20 (12–30) versus 75 (52.5–105), P DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered. PMID:27478641

  7. 急性卒中后谵妄%Delirium after acute stroke

    Institute of Scientific and Technical Information of China (English)

    邹会达; 潘速跃

    2014-01-01

    Delirium is a common complication after acute stroke.It usually indicates the poor outcome,higher mortality,longer hospital stay and increased dementia risk of patients.Therefore,the early detection and intervention of delirium after acute stroke have an important significance.This article reviews the pathogenesis,risk factors,diagnosis,assessment,treatment and outcome of delirium after stroke.%谵妄是急性卒中的一种常见并发症,通常提示患者转归不良、病死率较高、住院时间较长以及痴呆风险增高.因此,急性卒中后谵妄的早期发现和干预具有重要意义.文章从卒中后谵妄的发病机制、危险因素、诊断评估、治疗和转归等方面进行了综述.

  8. The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Marcos C. Lange

    2015-03-01

    Full Text Available Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS. Objective Compare the use of the neurovascular ultrasound examination (NVUE to digital subtraction angiography (DSA in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.

  9. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry: facilitating policy and system change at the hospital level.

    Science.gov (United States)

    LaBresh, Kenneth A

    2006-12-01

    The Paul Coverdell National Acute Stroke Registry prototypes baseline data collection demonstrated a significant gap in the use of evidenced-based interventions. Barriers to the use of these interventions can be characterized as relating to lack of knowledge, attitudes, and ineffective behaviors and systems. Quality improvement programs can address these issues by providing didactic presentations to disseminate the science and peer interactions to address the lack of belief in the evidence, guidelines, and likelihood of improved patient outcomes. Even with knowledge and intention to provide evidenced-based care, the absence of effective systems is a significant behavioral barrier. A program for quality improvement that includes multidisciplinary teams of clinical and quality improvement professionals has been successfully used to carry out redesign of stroke care delivery systems. Teams are given a methodology to set goals, test ideas for system redesign, and implement those changes that can be successfully adapted to the hospital's environment. Bringing teams from several hospitals together substantially accelerates the process by sharing examples of successful change and by providing strategies to support the behavior change necessary for the adoption of new systems. The participation of many hospitals also creates momentum for the adoption of change by demonstrating observable and successful improvement. Data collection and feedback are useful to demonstrate the need for change and evaluate the impact of system change, but improvement occurs very slowly without a quality improvement program. This quality improvement framework provides hospitals with the capacity and support to redesign systems, and has been shown to improve stroke care considerably, when coupled with an Internet-based decision support registry, and at a much more rapid pace than when hospitals use only the support registry. PMID:17178313

  10. Emerging Tools for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Christos Voukalis; Lip, Gregory Y. H.; Eduard Shantsila

    2016-01-01

    Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires the use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and a...

  11. Modelling of increased homocysteine in ischaemic stroke: post-hoc cross-sectional matched case-control analysis in young patients Aumento de homocisteína em acidente vascular cerebral isquêmico: análise post-hoc com casos controles em pacientes jovens

    Directory of Open Access Journals (Sweden)

    Penka A. Atanassova

    2007-03-01

    Full Text Available BACKGROUND & PURPOSE: Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS. However, especially in young adults, there is possibility of significantly increased IS risk due to increased ‘normal’ homocysteinaemia, i.e., ‘hidden’ (‘pathologically dormant’ prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY in gender- and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls. METHOD: We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques. RESULTS: IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL. At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72% model accuracy, p model=0.001. An increase of THCY with 1.0 µmol/L was associated with 22% higher risk of ischaemic stroke [adjusted OR=1.22 (95%CI 1.03?1.44]. In this way, novel lower cut-off value for HCY of 11.58 µmol/L in younger patients has been revealed (ROC AUC= 0.67, 95CI% 0.55-0.78, p=0.009. CONCLUSION: The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63%, specificity>68% irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.OBJETIVO: Hiperhomocisteinemia tem sido postulada como um dos fatores de risco na patogênese do acidente vascular

  12. The effect of out of hours presentation with acute stroke on processes of care and outcomes: analysis of data from the Stroke Improvement National Audit Programme (SINAP.

    Directory of Open Access Journals (Sweden)

    James T P Campbell

    Full Text Available BACKGROUND: There is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England. METHODS: SINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday-Friday 8am to 6pm and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan, and whether the patient received therapeutic interventions (such as thrombolysis. RESULTS: 45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779 had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency. Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06-1.21. CONCLUSION: Inequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.

  13. Acute Hepatic Failure as a Leading Manifestation in Exertional Heat Stroke

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    Qi Jin

    2012-01-01

    Full Text Available Background. Acute hepatic failure (AHF is uncommon as a leading symptom in patients with exertional heat stroke (EHS. Which stage to perform the liver transplantation for severe hepatic failure in EHS is still obscure at clinical setting. The conservative management has been reported to be successful in treating heat-stroke-associated AHF even in the presence of accepted criteria for emergency liver transplantation. Case Presentation. Here, we reported a 35-year-old male who presented with very high transaminases, hyperbilirubinemia, significant prolongation of the prothrombin time, and coma. No other causes for AHF could be identified but physical exhaustion and hyperthermia. Although the current patient fulfilled London criteria for emergency liver transplantation, he spontaneously recovered under conservative treatment including intravenous fluids, cooling, diuretics as mannitol, and hepatocyte growth-promoting factors. Conclusions. Meticulous supportive management could be justified in some selected cases of AHF due to EHS.

  14. Imaging, Intervention, and Workflow in Acute Ischemic Stroke: The Calgary Approach.

    Science.gov (United States)

    Zerna, C; Assis, Z; d'Esterre, C D; Menon, B K; Goyal, M

    2016-06-01

    Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention. PMID:26659339

  15. [Intervention effect of Tibetan patent medicine Ruyi Zhenbao pills in acute ischemic stroke in rats].

    Science.gov (United States)

    Liu, Rui-ying; Wu, Wei-jie; Tan, Rui; Xie, Bin; Zhong, Zhen-dong; He, Jing-ping; Chen, Yao; Kang, Xin-li

    2015-02-01

    Ischemic stroke is a primary cause of death and long-term disability all over the world. This disease is resulted from ischemia and hypoxia in brain tissues because of insufficient blood supply and causes a series of physiochemical metabolism disorders and physiological dysfunction. Its high disability ratio has bright huge burdens to society, governments and families. However, there is not efficacious medicine to treat it. In this study, a right middle cerebral artery occlusion was established in rats to observe the multi-path and multi-aspect intervention effects of Tibetan patent medicine Ruyi Zhenbao pills in reducing injuries to Nissl bodies, cerebral edema and inflammatory reactions and preventing cellular apoptosis, in order to lay a foundation for defining its therapeutic mechanism in acute ischemic stroke. PMID:26084187

  16. Safety and Efficacy of Acute Clopidogrel Load in Patients with Moderate and Severe Ischemic Strokes

    Science.gov (United States)

    Monlezun, Dominique J.; Rincon, Natalia; Tiu, Jonathan; Valmoria, Melisa

    2016-01-01

    Objective. To study the safety and efficacy of a clopidogrel loading dose in patients with moderate and severe acute ischemic strokes. Background. The safety of clopidogrel loading has been extensively investigated in patients with minor strokes and transient ischemic attacks. Methods. Acute ischemic stroke patients presenting consecutively to our center from 07/01/08 to 07/31/13 were screened. Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin) given within 6 hours of admission. We compared outcomes in patients with baseline NIHSS > 3 with and without clopidogrel loading. Results. Inclusion criteria were met for 1011 patients (43.6% females, 69.1% black, median age 63). Patients with clopidogrel loading had lower baseline NIHSS than patients who were not loaded (8 versus 9, p = 0.005). The two groups had similar risk for hemorrhagic transformation (p = 0.918) and symptomatic hemorrhage (p = 0.599). Patients who were loaded had a lower rate of neurological worsening (38.9% versus 48.3%, p = 0.031) and less in-hospital mortality (4.3% versus 13.4%, p = 0.001) compared to those who were not loaded. The likelihood of having a poor functional outcome did not differ between the two groups after adjusting for NIHSS on admission (OR = 0.71, 95% CI 0.4633–1.0906, p = 0.118). Conclusion. Clopidogrel loading dose was not associated with increased risk for hemorrhagic transformation or symptomatic intracranial hemorrhage in our retrospective study and was associated with reduced rates of neuroworsening following moderate and severe stroke.

  17. Albumin Administration in Acute Ischemic Stroke: Safety Analysis of the ALIAS Part 2 Multicenter Trial.

    Directory of Open Access Journals (Sweden)

    Michael D Hill

    Full Text Available Albumin treatment of ischemic stroke was associated with cardiopulmonary adverse events in previous studies and a low incidence of intracranial hemorrhage. We sought to describe the neurological and cardiopulmonary adverse events in the ALIAS Part 2 Multicenter Trial.Ischemic stroke patients, aged 18-83 and a baseline NIHSS ≥ 6, were randomized to treatment with ALB or saline control within 5 hours of stroke onset. Neurological adverse events included symptomatic intracranial hemorrhage, hemicraniectomy, neurological deterioration and neurological death. Cardiopulmonary adverse events included pulmonary edema/congestive heart failure, acute coronary syndromes, atrial fibrillation, pneumonia and pulmonary thromboembolism.Among 830 patients, neurological and cardiopulmonary adverse events were not differentially associated with poor outcome between ALB and saline control subjects. The rate of symptomatic intracranial hemorrhage in the first 24h was low overall (2.9%, 24/830 but more common in the ALB treated subjects (RR = 2.4, CI95 1.01-5.8. The rate of pulmonary edema/CHF in the first 48h was 7.9% (59/830 and was more common among ALB treated subjects (RR = 10.7, CI95 4.3-26.6; this complication was expected and was satisfactorily managed with mandated diuretic administration and intravenous fluid guidelines. Troponin elevations in the first 48h were common, occurring without ECG change or cardiac symptoms in 52 subjects (12.5%.ALB therapy was associated with an increase in symptomatic ICH and pulmonary edema/congestive heart failure but this did not affect final outcomes. Troponin elevation occurs routinely in the first 48 hours after acute ischemic stroke.ClincalTrials.gov NCT00235495.

  18. Endothelial Progenitor Cells Predict Cardiovascular Events after Atherothrombotic Stroke and Acute Myocardial Infarction. A PROCELL Substudy.

    Directory of Open Access Journals (Sweden)

    Elisa Cuadrado-Godia

    Full Text Available The aim of this study was to determine prognostic factors for the risk of new vascular events during the first 6 months after acute myocardial infarction (AMI or atherothrombotic stroke (AS. We were interested in the prognostic role of endothelial progenitor cells (EPC and circulating endothelial cells (CEC.Between February 2009 and July 2012, 100 AMI and 50 AS patients were consecutively studied in three Spanish centres. Patients with previously documented coronary artery disease or ischemic strokes were excluded. Samples were collected within 24h of onset of symptoms. EPC and CEC were studied using flow cytometry and categorized by quartiles. Patients were followed for up to 6 months. NVE was defined as new acute coronary syndrome, transient ischemic attack (TIA, stroke, or any hospitalization or death from cardiovascular causes. The variables included in the analysis included: vascular risk factors, carotid intima-media thickness (IMT, atherosclerotic burden and basal EPC and CEC count. Multivariate survival analysis was performed using Cox regression analysis.During follow-up, 19 patients (12.66% had a new vascular event (5 strokes; 3 TIAs; 4 AMI; 6 hospitalizations; 1 death. Vascular events were associated with age (P = 0.039, carotid IMT≥0.9 (P = 0.044, and EPC count (P = 0.041 in the univariate analysis. Multivariate Cox regression analysis showed an independent association with EPC in the lowest quartile (HR: 10.33, 95%CI (1.22-87.34, P = 0.032] and IMT≥0.9 [HR: 4.12, 95%CI (1.21-13.95, P = 0.023].Basal EPC and IMT≥0.9 can predict future vascular events in patients with AMI and AS, but CEC count does not affect cardiovascular risk.

  19. Early outcome after intravenous thrombolysis in patients with acute ischemic stroke

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    Pornpatr A Dharmasaroja

    2011-01-01

    Full Text Available Background : Patients with acute ischemic stroke who had early neurological improvement had better functional outcome. The purpose of this study was to determine factors associated with early clinical improvement and early worsening in patients with acute ischemic stroke treated with intravenous thrombolysis. Patients and Methods : Patients treated with intravenous recombinant tissue plasminogen activator (rtPA between August 2008 and November 2010 were the subjects of this study. Early improvement was defined by marked, clinical improvement or complete recovery at 24 h (National Institutes of Health Stroke Scale (NIHSS 0-4 at 24 h. Early worsening was defined by an increase in NIHSS ≥1 from baseline. The baseline characteristics were compared between patients with and without outcome of interest. Results : Of the 203 patients studied, 19 (9.4% patients had complete recovery and 68 (33.5% patients had marked clinical improvement (NIHSS 1-4 at 24 h. Most patients with early clinical improvement (86% had favorable outcome at three months. Of the 22 (10.8% patients who had early clinical worsening, only three (14% patients achieved favorable outcome at three months and six (29% patients died. Multivariate analysis revealed that older age (≥70 years old (odd ratio (OR 0.498, P = 0.049, severe stroke (NIHSS ≥15 (OR 0.154, P < 0.0001 and having intracerebral hemorrhage (ICH (OR 0.364, P = 0.032 were inversely associated with early improvement. History of transient ischemic attack (TIA (OR 7.724, P = 0.043 and ICH (OR 4.477, P = 0.008 were related to early worsening. Conclusions : The presence of early clinical improvement or worsening within 24 h after treatment with rtPA had major impact on the outcome at three months.

  20. Ankylosing spondylitis and risk of ischaemic heart disease

    DEFF Research Database (Denmark)

    Essers, Ivette; Stolwijk, Carmen; Boonen, Annelies;

    2016-01-01

    OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls. METHODS: All patients...

  1. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Gang Guo; Yonggui Yang; Weiqun Yang

    2012-01-01

    We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.

  2. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Eri Iwasawa; Masahiko Ichijo; Satoru Ishibashi; Takanori Yokota

    2016-01-01

    In acute ischemic stroke, collateral circulation plays an important role in maintaining blood lfow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate with-out hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by lfuid shear stress, which occurs be-tween the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate recep-tor 1, which is a known shear-stress mechanosensing protein.

  3. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Eri Iwasawa

    2016-01-01

    Full Text Available In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress, which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1, which is a known shear-stress mechanosensing protein.

  4. Do functional walk tests reflect cardiorespiratory fitness in sub-acute stroke?

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    Bayley Mark T

    2006-09-01

    Full Text Available Abstract Background and purpose The Six-Minute Walk Test (6MWT has been employed as a measure of functional capacity, but its relationship to cardiorespiratory fitness in stroke is not well established. Gait speed measured over short distances is commonly used as an index of walking competency following stroke. We evaluated the relationship between the 6MWT, aerobic fitness (VO2peak and walking competency in sub-acute stroke. Methods Thirty-six individuals (mean age ± SD, 64.6 ± 14.4 years; time post-stroke 16.2 ± 13.3 days were evaluated using the 6MWT (distance, speed, heart rate, a maximal exercise test (VO2peak, heart rate, exercise test duration, and walking competency using a five meter walk (speed, symmetry ratio. Correlation analyses were used to examine the relationships between these outcomes. Results There was a strong correlation between the 6MWT and five meter walk velocity for preferred (r = 0.79 and fast (r = 0.82 speed (p 2peak (r = 0.56, p Conclusion The speed selected during the 6MWT was strongly related to the velocities selected during the five meter walk distance (intermediate to the selected preferred and fast speeds. Although the 6MWT may be challenging to the cardiorespiratory system, it appears to be more strongly influenced by potential limits to walking speed rather than cardiorespiratory capacity. As a result, this test is not, by itself, an adequate measure of aerobic fitness early after stroke.

  5. Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke

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    Amiri-Nikpour MR

    2014-12-01

    Full Text Available Mohammad Reza Amiri-Nikpour,1 Surena Nazarbaghi,1 Babak Ahmadi-Salmasi,1 Tayebeh Mokari,2 Urya Tahamtan,2 Yousef Rezaei3 1Department of Neurology, Imam Khomeini Hospital, 2School of Medicine, 3Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran Background: Cerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow. Methods: In a randomized, double-blinded, placebo-controlled trial, 46 patients who had acute focal ischemic stroke were randomly assigned into two groups to receive intravenously either 30 mL of cerebrolysin diluted in normal saline daily for 10 days (n=23 or normal saline alone (n=23 adjunct to 100 mg of aspirin daily. All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index (PI of their cerebral arteries at baseline as well as on days 30, 60, and 90. Results: The patients’ mean age was 60±9.7 years, and 51.2% of patients were male. The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 (median 10, interquartile range 9–11, P=0.008 and day 90 (median 11, interquartile range 10–13.5, P=0.001. The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30, 60, and 90 (P<0.05. One patient in the cerebrolysin group and two patients in the placebo group died before day 30 (4.3% versus 8.7%. Conclusion: Cerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke. Keywords: ischemic stroke, cerebrolysin, neuroprotection, NIHSS, mean

  6. Dynamic CT Perfusion Imaging for the Detection of Crossed Cerebellar Diaschisis in Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Young Wook; Kim, Seo Hyun; Lee, Ji Young; Whang, Kum; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub; Brain Reserch Group [Wonju Christian Hospital, Yonsei University Wonju University College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Although the detection of crossed cerebellar diaschisis (CCD) by means of different imaging modalities is well described, little is known about its diagnosis by computed tomography perfusion (CTP) imaging. We investigated the detection rate of CCD by CTP imaging and the factors related to CCD on CTP images in patients with acute ischemic stroke. CT perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) obtained from 81 consecutive patients affected by an acute ischemic stroke were retrospectively reviewed. Whole-brain perfusion maps were obtained with a multichannel CT scanner using the toggling-table technique. The criteria for CCD was a unilateral supratentorial ischemic lesion and an accompanying decrease in perfusion of the contralateral cerebellar hemisphere on the basis of CTP maps by visual inspection without a set threshold. Maps were quantitatively analyzed in CCD positive cases. The criteria for CCD were fulfilled in 25 of the 81 cases (31%). Detection rates per CTP map were as follows: MTT (31%) > TTP (21%) > CBF (9%) > CBV (6%). Supratentorial ischemic volume, degree of perfusion reduction, and infratentorial asymmetry index correlated strongly (R, 0.555-0.870) and significantly (p < 0.05) with each other in CCD-positive cases. It is possible to detect CCD on all four of the CTP-based maps. Of these maps, MTT is most sensitive in detecting CCD. Our data indicate that CTP imaging is a valid tool for the diagnosis of CCD in patients affected by an acute hemispheric stroke.

  7. Iterative Reconstruction Improves Both Objective and Subjective Image Quality in Acute Stroke CTP.

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    Fabian Flottmann

    Full Text Available Computed tomography perfusion (CTP imaging in acute ischemic stroke (AIS suffers from measurement errors due to image noise. The purpose of this study was to investigate if iterative reconstruction (IR algorithms can be used to improve the diagnostic value of standard-dose CTP in AIS.Twenty-three patients with AIS underwent CTP with standardized protocol and dose. Raw data were reconstructed with filtered back projection (FBP and IR with intensity levels 3, 4, 5. Image quality was objectively (quantitative perfusion values, signal-to-noise ratio (SNR, contrast-to-noise ratio (CNR and subjectively (overall image quality assessed. Ischemic core and perfusion mismatch were visually rated. Discriminative power for tissue outcome prediction was determined by the area under the receiver operating characteristic curve (AUC resulting from the overlap between follow-up infarct lesions and stepwise thresholded CTP maps.With increasing levels of IR, objective image quality (SNR and CNR in white matter and gray matter, elimination of error voxels and subjective image quality improved. Using IR, mean transit time (MTT was higher in ischemic lesions, while there was no significant change of cerebral blood volume (CBV and cerebral blood flow (CBF. Visual assessments of perfusion mismatch changed in 4 patients, while the ischemic core remained constant in all cases. Discriminative power for infarct prediction as represented by AUC was not significantly changed in CBV, but increased in CBF and MTT (mean (95% CI: 0.72 (0.67-0.76 vs. 0.74 (0.70-0.78 and 0.65 (0.62-0.67 vs 0.67 (0.64-0.70.In acute stroke patients, IR improves objective and subjective image quality when applied to standard-dose CTP. This adds to the overall confidence of CTP in acute stroke triage.

  8. Perfusion CT in acute stroke; Stellenwert der CT-Perfusion fuer die Therapie des Schlaganfalls

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    Eckert, Bernd [Asklepios Klinik Altona (Germany). Radiologie und Neuroradiologie; Roether, Joachim [Asklepios Klinik Altona (Germany). Neurologische Abt.; Fiehler, Jens [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention; Thomalla, Goetz [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neurologie, Kopf- und Neurozentrum

    2015-06-15

    Modern multislice CT scanners enable multimodal protocols including non-enhanced CT, CT angiography, and CT perfusion. A 64-slice CT scanner provides 4-cm coverage. To cover the whole brain, a 128 - 256-slice scanner is needed. The use of perfusion CT requires an optimized scan protocol in order to reduce exposure to radiation. As compared to non-enhanced CT and CT angiography, the use of CT perfusion increases detection rates of cerebral ischemia, especially small cortical ischemic lesions, while the detection of lacunar and infratentorial stroke lesions remains limited. Perfusion CT enables estimation of collateral flow in acute occlusion of large intra- or extracranial arteries. Currently, no established reliable thresholds are available for determining infarct core and penumbral tissue by CT perfusion. Moreover, perfusion parameters depend on the processing algorithms and the software used for calculation. However, a number of studies point towards a reduction of cerebral blood volume (CBV) below 2 ml/100 g as a critical threshold that identifies infarct core. Large CBV lesions are associated with poor outcome even in the context of recanalization. The extent of early ischemic signs on non-enhanced CT remains the main parameter from CT imaging to guide acute reperfusion treatment. Nevertheless, perfusion CT increases diagnostic and therapeutic certainty in the acute setting. Similar to stroke MRI, perfusion CT enables the identification of tissue at risk of infarction by the mismatch between infarct core and the larger area of critical hypoperfusion. Further insights into the validity of perfusion parameters are expected from ongoing trials of mechanical thrombectomy in stroke.

  9. Perfusion computed tomography relative threshold values in definition of acute stroke lesions

    International Nuclear Information System (INIS)

    Perfusion computed tomography (CT) is a relatively new technique that allows fast evaluation of cerebral hemodynamics by providing perfusion maps and gives confirmation of perfusion deficits in ischemic areas. Some controversies exist regarding accuracy of quantitative detection of tissue viability: penumbra (tissue at risk) or core (necrosis). To define brain tissue viability grade on the basis of the perfusion CT parameters in acute stroke patients. A multimodal CT imaging protocol; unenhanced CT of the brain, CT angiography of head and neck blood vessels, followed by brain perfusion CT and 24 h follow-up brain CT was performed. Perfusion deficits were detected first visually, with subsequent manual quantitative and relative measurements in affected and contra-lateral hemisphere in 87 acute stroke patients. Visual perfusion deficit on perfusion CT images was found in 78 cases (38 women, 40 men; mean age, 30–84 years). Penumbra lesions (n = 49) and core lesions (n = 42) were detected by increased mean transit time (MTT) on perfusion CT maps in comparison to contra-lateral hemispheres. Cerebral blood volume (CBV) mean values in the penumbra group were increased in the penumbra group and decreased in the core group. Cerebral blood flow (CBF) values were decreased in penumbra and markedly decreased in core lesion. Perfusion CT measurements are reliable in estimation of penumbra and core lesions in acute stroke patients, if relative threshold values are used. The most accurate parameter of hypoperfusion is increased MTT above 190%. Relative threshold values for irreversible lesion are CBF <30–40% and CBV <40% in comparison to contra-lateral hemisphere. Penumbra lesion is characterized by MTT increase and CBF decrease, while CBV shows variable values

  10. Are heat stroke and physical exhaustion underestimated causes of acute hepatic failure?

    Institute of Scientific and Technical Information of China (English)

    Kilian Weigand; Carina Riediger; Wolfgang Stremmel; Christa Flechtenmacher; Jens Encke

    2007-01-01

    While cardiopulmonary symptoms are common in patients undergoing classical or, due to physical exercise,exertional heat stroke, the failure of other organs is a rarely described phenomenon. Here we present two cases of acute hepatic failure, one due to classic heat shock, while the other occurred while the patient was doing a marathon-type running. Both cases presented with very high transaminases and significantly elevated international normalized ratio (INR). No other causes for liver failure could be identified but physical exhaustion and hyperthermia.

  11. The role of THRIVE score in prediction of outcomes of acute ischemic stroke patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    尤寿江

    2014-01-01

    Objective To study whether the total health risks in vascular events(THRIVE)score could predict the prognosis in the acute ischemic stroke patients with atrial fibrillation.Methods A total of 169 patients were enrolled in the study,with NIH Stroke Scale(NIHSS)score,THRIVE score and CHADS2score given to each patients at admission and modified Rankin Scale(mRS)given at3 months follow up.All patients were divided into the

  12. Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: A hospital-based study from south India

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    Boddu Demudu

    2010-01-01

    Full Text Available Background : Despite the increasing use of recombinant tissue plasminogen activator (rt-PA in acute ischemic stroke, uncertainty persists about the short- and long-term outcome of the thrombolysed patients. Objective : To identify predictors of major neurological improvement at 24 h after intravenous rt-PA administration in patients of acute ischemic stroke and their relationship with outcome at 12 months. Materials and Methods : We analyzed the data of the patients with acute ischemic stroke treated as per the National Institute of Neurological Disorders and Stroke (NINDS criteria with intravenous rt-PA between January 2000 and June 2009 at a tertiary care center in south India. Major neurological improvement was defined by an 8-point improvement in National Institute of Health Stroke Scale (NIHSS score or an NIHSS score of 0 or 1 at 24 h. Good outcome was defined as a 12-month modified Rankin Scale (mRS of 0 to 1. Results : Of the 72 patients with acute ischemic stroke treated with intravenous rt-PA, 23 (32% patients had major neurological improvement at 24 h. Age <60 years (OR 1.9, 95% CI 1.7 to3.2, admission glucose levels <8 mmol/L (OR 3.87, 95% CI 1.9 to 9.2 and mild to moderate baseline stroke severity (NIHSS median score 10+ 6 were associated with major neurological improvement after adjusting for co variables. Major neurological improvement at 24 h was an independent predictor of good outcome (mRS=1 at 12 months (OR 13.9, 95% CI 6.84 to 40.2. Conclusions : Age <60 years, glucose levels <8 mmol/L and mild to moderate stroke severity (NIHSS median score 10±6 was associated with major neurological improvement after intravenous rt-PA. Major neurological improvement at 24 h after the administration of intravenous thrombolysis independently predicted good outcome at 12 months.

  13. Detection of Early Vessel Leakiness in Acute Ischemic Stroke Using Computed Tomography Perfusion May Indicate Hemorrhagic Transformation

    International Nuclear Information System (INIS)

    This short communication presents significantly increased permeability in two patients with acute stroke, indicating an early blood-brain barrier disruption. Neither of the patients had undergone any thrombolytic therapy and hemorrhaged later. Increased permeability was assessed in both patients using a distributed-parameter model of capillary-tissue exchange. Our findings indicate that early physiologic imaging in stroke may identify patients with a high risk of hemorrhagic transformation by revealing pathologic vascular changes and, thus, guide therapeutic options

  14. Detection of Early Vessel Leakiness in Acute Ischemic Stroke Using Computed Tomography Perfusion May Indicate Hemorrhagic Transformation

    Energy Technology Data Exchange (ETDEWEB)

    Bisdas, S.; Hartel, M.; Cheong, L.H.; Koh, T.S. [Dept. of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt (Germany)

    2007-04-15

    This short communication presents significantly increased permeability in two patients with acute stroke, indicating an early blood-brain barrier disruption. Neither of the patients had undergone any thrombolytic therapy and hemorrhaged later. Increased permeability was assessed in both patients using a distributed-parameter model of capillary-tissue exchange. Our findings indicate that early physiologic imaging in stroke may identify patients with a high risk of hemorrhagic transformation by revealing pathologic vascular changes and, thus, guide therapeutic options.

  15. Early prognosis of survival or death after a recent stroke by blood levels of acute-phase proteins.

    Science.gov (United States)

    Ionescu, D A; Haţegan, D; Jipescu, I; Steinbruch, L; Ghiţescu, M

    1991-01-01

    From 129 patients with a recent stroke 105 survived and 24 died within 3 weeks from stroke-onset. At around 40 hours after the latter, the blood-levels of the acute-phase proteins ceruloplasmin and albumin did not forecast the death of the respective patients, but, in contradistinction, the level of fibrinogen was significantly higher in those who eventually died, than in those who survived. Therefore, a higher level of fibrinogen could be a risk-factor for death after stroke.

  16. Integrating palliative care within acute stroke services: developing a programme theory of patient and family needs, preferences and staff perspectives

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    Burton Christopher R

    2012-11-01

    Full Text Available Abstract Background Palliative care should be integrated early into the care trajectories of people with life threatening illness such as stroke. However published guidance focuses primarily on the end of life, and there is a gap in the evidence about how the palliative care needs of acute stroke patients and families should be addressed. Synthesising data across a programme of related studies, this paper presents an explanatory framework for the integration of palliative and acute stroke care. Methods Data from a survey (n=191 of patient-reported palliative care needs and interviews (n=53 exploring experiences with patients and family members were explored in group interviews with 29 staff from 3 United Kingdom stroke services. A realist approach to theory building was used, constructed around the mechanisms that characterise integration, their impacts, and mediating, contextual influences. Results The framework includes two cognitive mechanisms (the legitimacy of palliative care and individual capacity, and behavioural mechanisms (engaging with family; the timing of intervention; working with complexity; and the recognition of dying through which staff integrate palliative and stroke care. A range of clinical (whether patients are being ‘actively treated’, and prognostic uncertainty and service (leadership, specialty status and neurological focus factors appear to influence how palliative care needs are attended to. Conclusions Our framework is the first, empirical explanation of the integration of palliative and acute stroke care. The specification in the framework of factors that mediate integration can inform service development to improve the outcomes and experiences of patients and families.

  17. Thrombolytic treatment in the oldest-old patient with acute ischemic stroke: an update on current evidence

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    Fabiola Maioli

    2013-09-01

    Full Text Available The incidence of ischemic stroke rises exponentially with age, with a steep increase in the age interval between 75 and 85 years. Thrombolytic therapy restores cerebral blood flow in patients with acute ischemic stroke of any etiology by using drugs that dissolve blood clots. Infusion for 1 h of alteplase at the dose of 0.9 mg/kg within 3 h of the start of the symptoms is associated to a 30% increase in the likelihood of gaining a favorable outcome with respect to placebo. There is strong evidence that selected patients with ischemic stroke may benefit from intravenous thrombolysis when treated within 3 h. The aim of the study was to evaluate available evidence for the efficacy and safety of thrombolytic therapy in patients with ischemic stroke aged 80 years and over. Compared to younger stroke patients treated with thrombolytic therapy, those aged 80 years and over have higher acute mortality due to symptomatic intracranial hemorrhage. However, functional outcome at six months is significantly better for over-80-year-olds than younger patients. There is a need for screening tools that take into account pre-stroke functional and cognitive status that are able to identify those over-80-year-old patients with ischemic stroke who can most benefit from thrombolytic treatment. Available evidence supports further recruitment of oldest-old patients into ongoing trials of thrombolysis.

  18. Retraction statement: Dynamics of Cytochrome C Oxidase Activity in Acute Ischemic Stroke' by Selaković, V.M., Jovanović, M.D., Mihajlović, R.R. and Radenović, L.L.J.

    Science.gov (United States)

    2016-10-01

    The above article from Acta Neurologica Scandinavica, published online on 7 April 2005 in Wiley Online Library (wileyonlinelibrary.com) and in Volume 111, pp. 329-332, has been retracted by agreement between the journal Editor in Chief, Professor Elinor Ben-Menachem, and John Wiley & Sons Ltd. The article has been retracted because a similar article had previously been published in the Jugoslovenska medicinska biohemija in 2003. The authors presumed that since the journal was no longer existing, they felt the need to re-publish their work in Acta Neuorologica Scandinavica. However, in the consideration of the Journal, this constitutes dual publication. References SelakovićVM, JovanovićMD, MihajlovićR, RadenovićLLJ. Cytochrome c oxidase in patients with acute ischaemic brain disease. Jugoslovenska medicinska biohemija. 2003;22:329-334. SelakovićVM, JovanovićMD, MihajlovićRR, RadenovićLLJ. Dynamics of cytochrome c oxidase activity in acute ischemic stroke. Acta Neurol Scand. 2005;111:329-332.

  19. Generalization of the Right Acute Stroke Prevention Strategies in Reducing in-Hospital Delays.

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    Qiang Huang

    Full Text Available The aim of this study was to reduce the door-to-needle (DTN time of intravenous thrombolysis (IVT in acute ischemic stroke (AIS through a comprehensive, hospital-based implementation strategy. The intervention involved a systemic literature review, identifying barriers to rapid IVT treatment at our hospital, setting target DTN time intervals, and building an evolving model for IVT candidate selection. The rate of non-in-hospital delay (DTN time ≤ 60 min was set as the primary endpoint. A total of 348 IVT cases were enrolled in the study (202 and 146 in the pre- and post-intervention group, respectively. The median age was 61 years in both groups; 25.2% and 26.7% of patients in the pre- and post-intervention groups, respectively, were female. The post-intervention group had higher rates of dyslipidemia and minor stroke [defined as National Institutes of Health Stroke Scale (NIHSS ≤ 3]; less frequent atrial fibrillation; higher numbers of current smokers, heavy drinkers, referrals, and multi-model head imaging cases; and lower NIHSS scores and blood sugar level (all P 0.05. These findings indicate that it is possible to achieve a DTN time ≤ 60 min for up to 60% of hospitals in the current Chinese system, and that this logistical change can yield a notable improvement in the outcome of IVT patients.

  20. The Effect of Mannitol Treatment on Renal Functions in Acute Stroke

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    Neslihan Eşkut

    2010-06-01

    Full Text Available OBJECTIVE: Mannitol is an osmotic diuretic agent and reduces intracranial pressure. The most serious side effect of mannitol is kidney dysfunction. In this study, renal functions in acute stroke patients treated with mannitol were evaluated. METHODS: One hundred and twenty-two patients followed in the neurology intensive care unit with the diagnosis of stroke and treated with fractionated mannitol for 5 days were evaluated retrospectively. Ninety-six patients had ischemic and 26 had hemorrhagic stroke. Mean age was 69.9 ± 11.8 (18-91 years. Serum urea, creatinine and electrolyte levels measured before and on the second, third, fourth, fifth and tenth days of treatment were compared statistically with paired sample t test. RESULTS: The average urea and creatinine levels on the second, third, fourth and fifth days of treatment were significantly higher than the baseline (p< 0.05. On the other hand, mannitol treatment did not change average sodium, potassium and chlorine levels. The creatinine levels had returned to the normal range on the tenth day of treatment, but the urea levels, although decreased, did not fall to the normal range. CONCLUSION: Our results support the view that close monitoring of renal function is necessary in patients treated with mannitol.